Do you have a tattoo or two? If so, you’ve got lots of company. About one in five Americans have at least one tattoo, and in the last few years, the number sporting two or more has nearly doubled from 8 percent to 14 percent.

But the growing popularity of tattoos doesn’t mean getting one is free of risk. Increasing reports of allergic reactions and infections led the Food and Drug Administration (FDA) to issue a warning about tattoo inks and needles. The FDA does not regulate tattoo ink and only gets involved when problems are reported.

What are the risks?

Injected pigments can cause allergic reactions and sometimes permanent scarring. Infections can also develop when needles and other tools aren’t properly sterilized. The risk is similar to getting a shot from your health care provider – any time skin is pierced there is an opportunity for infection. It’s also why you should never get a tattoo without doing your homework first. While you cannot remove every risk, the likelihood of experiencing negative side effects is reduced when you go to a licensed tattoo parlor with a good track record.

What’s in ink?

Depending on color, tattoo ink can include iron oxide, mercury sulfide, ferric hydrate, aluminum and manganese, any of which can cause blistering and itching. In rare instances, they can also cause anaphylactic shock and several other severe side effects. Red and yellow inks are particularly problematic.

While poor hygiene can cause serious infections and the spread of blood-borne diseases like hepatitis C, Dr. Linda Katz, director of the FDA’s Office of Cosmetics and Colors, said the bigger risk in the U.S. is ink contaminated with bacteria and mold. This problem often develops when non-sterile water is used to dilute the pigments. Sometimes this happens during manufacturing, which is why the agency warns against buying do-it-yourself tattoo kits and ink from unknown vendors on the Internet. It can also happen at the tattoo parlor, which is why it’s important to research both the artist and the business before getting a tattoo.

“There’s no sure-fire way to tell if the ink is safe,” said Katz. “Just looking at it or smelling it won’t tell you if it’s contaminated. An ink can be contaminated even if the container is sealed or wrapped, or the label asserts the product is sterile. In fact, ink could become contaminated at any point in the production process.”

Getting a tattoo? Here’s what to look for and insist on to reduce your risk for infection:

• Staff should be licensed and the studio should be clean.
• The studio should have an autoclave (equipment used to sterilize equipment). If there is no autoclave, do not get a tattoo.
• Needles and other “sharps” should only be used once and should be opened (from individual packages) in front of you before the procedure.
• Staff should wear new latex gloves during each procedure.
• Inks should be placed in a single-use cup and then disposed of. Ink should never be taken directly from the main source bottle or returned to that bottle.
• Ask questions: How long has the person been tattooing? Are they knowledgeable? Ask to see photos of their work. Do you like it?
• Read and understand the aftercare instructions before getting a tattoo.

If you feel uncomfortable in a studio or with the staff, leave.

What if you develop a problem?

See a health care professional, preferably a dermatologist, immediately. Ointments provided by tattoo parlors will not treat infections. A dermatologist can determine how serious the problem is and prescribe appropriate treatment.

Tattoos can be beautiful, but giving some serious thought before you go under the needle can save you regret and cash later.

[Janet Lubman Rathner]