Tattoos, toxins and the immune system – what you need to know before you get inked

From minimalist wrist designs to full sleeves, body art has become so common that it barely raises an eyebrow. But while the personal meaning of a tattoo may be obvious, the biological consequences are far less visible. Once tattoo ink enters the body, it does not stay put. Beneath the skin, tattoo pigments interact with the immune system in ways scientists are only just beginning to understand.

Tattoos are generally considered safe, but growing scientific evidence suggests tattoo inks are not biologically inert. The key question is no longer whether tattoos introduce foreign substances into the body, but how toxic those substances might be and what that means for long-term health.

Tattoo inks are complex chemical mixtures. They contain pigments that give colour, liquid carriers that help distribute the ink, preservatives to prevent microbial growth, and small amounts of impurities. Many pigments currently in use were originally developed for industrial applications such as car paint, plastics and printer toner, rather than for injection into human skin.

Some inks contain trace amounts of heavy metals, including nickel, chromium, cobalt and occasionally lead. Heavy metals can be toxic at certain levels and are well known for triggering allergic reactions and immune sensitivity.

Tattoo inks can also contain organic compounds, including azo dyes and polycyclic aromatic hydrocarbons.

Azo dyes are synthetic colourants widely used in textiles and plastics. Under certain conditions, such as prolonged exposure to sunlight or during laser tattoo removal, they can break down into aromatic amines. These chemicals have been linked to cancer and genetic damage in laboratory studies.

Polycyclic aromatic hydrocarbons, often shortened to PAHs, are produced during incomplete burning of organic material and are found in soot, vehicle exhaust and charred food. Black tattoo inks, commonly made from carbon black, may contain these compounds, some of which are classified as carcinogenic.

Coloured inks, particularly red, yellow and orange, are more frequently associated with allergic reactions and chronic inflammation. This is partly due to metal salts and azo pigments that can degrade into potentially toxic aromatic amines.

Tattooing involves injecting ink deep into the dermis, the layer of skin beneath the surface. The body recognises pigment particles as foreign material. Immune cells attempt to remove them, but the particles are too large to be fully cleared. Instead, they become trapped inside skin cells, which is what makes tattoos permanent.

Tattoo ink does not remain confined to the skin. Studies show that pigment particles can migrate through the lymphatic system and accumulate in lymph nodes. Lymph nodes are small structures that filter immune cells and help coordinate immune responses. The long-term health effects of ink accumulation in these tissues remain unclear, but their central role in immune defence raises concerns about prolonged exposure to metals and organic toxins.

Tattoos and the immune system

A recent study suggests that commonly used tattoo pigments can influence immune activity, trigger inflammation and reduce the effectiveness of certain vaccines. Researchers found that tattoo ink is taken up by immune cells in the skin. When these cells die, they release signals that keep the immune system activated, leading to inflammation in nearby lymph nodes for up to two months.

The study also found that tattoo ink present at a vaccine injection site altered immune responses in a vaccine-specific way. Notably, it was associated with a reduced immune response to the COVID-19 vaccine. This does not mean tattoos make vaccines unsafe. Rather, it suggests tattoo pigments can interfere with immune signalling, the chemical communication system immune cells use to coordinate responses to infection or vaccination, under certain conditions.

At present, there is no strong epidemiological evidence linking tattoos to cancer in humans. However, laboratory and animal studies suggest potential risks. Certain tattoo pigments can degrade over time, or when exposed to ultraviolet light or laser tattoo removal, forming toxic and sometimes carcinogenic byproducts.

Many cancers take decades to develop, making these risks difficult to study directly, especially given how recently widespread tattooing has become.

The most well-documented health risks of tattoos are allergic and inflammatory reactions. Red ink is particularly associated with persistent itching, swelling and granulomas. Granulomas are small inflammatory nodules that form when the immune system attempts to isolate material it cannot remove.

These reactions can appear months or years after a tattoo is applied and may be triggered by sun exposure or changes in immune function. Chronic inflammation has been linked to tissue damage and increased disease risk. For people with autoimmune conditions or weakened immune systems, tattoos may pose additional concerns.

Infection risks

Like any procedure that punctures the skin, tattooing carries some risk of infection. Poor hygiene can lead to infections such as Staphylococcus aureus, hepatitis B and C and, in rare cases, atypical mycobacterial infections.

One of the biggest challenges in assessing tattoo toxicity is the lack of consistent regulation. In many countries, tattoo inks are regulated far less strictly than cosmetics or medical products, and manufacturers may not be required to disclose full ingredient lists.

The European Union has introduced stricter limits on hazardous substances in tattoo inks, but globally, oversight remains uneven.

For most people, tattoos do not cause serious health problems, but they are not risk-free. Tattoos introduce substances into the body that were never designed for long-term residence in human tissue, some of which can be toxic under certain conditions.

The main concern is cumulative exposure. As tattoos become larger, more numerous and more colourful, the total chemical burden increases. Combined with sun exposure, ageing, immune changes or laser removal, this burden may have consequences that science has not yet fully uncovered.

Tattoos remain a powerful form of self-expression, but they also represent lifelong chemical exposure. While current evidence does not suggest widespread danger, growing research highlights important unanswered questions about toxicity, immune effects and long-term health. As tattooing continues to rise worldwide, the case for better regulation, transparency and sustained scientific investigation becomes increasingly difficult to ignore.

Manal Mohammed does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.