Last January, the Monroe County Department of Public Health in upstate New York received an unusual report. A patient, newly tattooed, had paid a visit to a local dermatologist complaining of a persistent, raised red rash on his arm that appeared after he received a tattoo on the same area three months before. A biopsy of the tattoo revealed Mycobacterium chelonae, a rapidly growing, non-tuberculous mycobacteria. The case raised red flags for Kennedy, a physician and investigator at the health department. “From the perspective of a local health department, investigating tattoo infections is not necessarily something that is typical for us,” Kennedy said. “This was new turf for us.”
Kennedy and his colleagues, John Ricci, M.S. and Brenden Bedard, M.P.H., interviewed the itchy index patient—the first patient diagnosed with the rash—only to discover that other patrons tattooed in the same parlor by the same Rochester tattoo artist may have had similar reactions. It was up to Kennedy and his team to determine, for sure, what could have caused these infections.
The epidemiologists interviewed the tattoo artist, sampled water, ink and surfaces in the parlor, and biopsied the tattooed lesions of the rash in 18 of the 19 patients they believed were caused by the body art. In the end, Mycobacterium chelonae was isolated in 14 samples taken from the patients. The findings of the investigation were published in September in the New England Journal of Medicine.
With tattoos’ rise in popularity, the findings were disconcerting. Twenty-one percent of adults in the United States have one or more tattoos – an increase from 14 percent in 2008, according to a 2012 Harris Poll of 2,016 adults. Little monitoring and evaluation of tattoo parlors and their practices, as well as lax reporting and record keeping of artists’ inks and patrons’ tattoo-related infections, may mean that cutaneous mycobacterial infections are undercounted, said Kennedy and his colleagues. What’s more, the surprising culprit in the Rochester-area infections highlights a gap in how tattooing and artists’ materials, such as ink, are regulated.
Anyone who has a tattoo or knows someone who does can attest to their literal and figurative infectiousness. Tattooees usually show them off with pride, humor and satisfaction. Rarely will a first tattoo be the last. And tattooing is no longer performed solely in commercial parlors. Some underground artists tattoo their friends and other comers at home or other locations – out of sight of the public health authorities charged with keeping the practice safe. That compounds the subversive nature of an already rebellious activity.
“There are worse things that young people with disposable time and incomes can participate in,” said Caleb, a Brooklyn painter who tattoos his friends for free as a recreational a pastime. For bone fide commercial tattoo artists and recreational tattooers like Caleb, many of whom pride themselves on the precautions they take to keep their patrons safe, the specter of infection raises uncomfortable questions about how involved government can be in safeguarding patrons, particularly in casual, non-professional settings. On separate occasions, we spoke with Caleb, whose name has been changed here to prevent his being identified if pending tattoo regulations are enacted, and three of the NEJM article authors about this tension.
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Photos by Clay Kesseck
Edited by Jordan Lite. Additional research by Arti Virkud.