Alergias respiratórias: conheça as causas e como se prevenir

Can inks used in tattoos cause disease? understand the risks

For a long time, the use of non-sterile needles or even their reuse were the main concerns of health authorities and health professionals when it comes to tattoo. More recently, the paints used for the procedures have entered even further into the radar of specialists, who seek to identify and minimize the potential harm caused by these products.

In January, the European Chemicals Agency (ECHA) limited the use of more than 4,000 substances present in tattoo inks (mostly colored) and linked to some kind of health problem. Some examples are azo dyes, carcinogenic aromatic amines, polycyclic aromatic hydrocarbons (PAHs), metals and methanolrelated to allergies, irritations, induction of genetic mutations or cancer. According to the agency, the intention is not to ban tattoos, but to make the colors used in them safer.

Although the most serious concerns about the pigments contained in the inks are their carcinogenic potential and the potential to cause changes in DNA, there is still no way to link these effects to the products. “It is a risk of application, they have toxic chemical properties and include carcinogenic substances. But, in a practical way, we have no proof that there is an association between the application of paint and the appearance of cancer or if it is a coincidence”, explains the doctor. dermatologist Moyses Lemos.

A tattoo ink is made up of two parts: the pigment and the carrier solution, which holds the substances together, makes the pigment more soluble and gives the product its texture. The dermatologist points out that, “in general, paints have dozens of known allergens, metallic substances and organic pigments that remain relatively uncontrolled”. This is because allergic reactions to pigments, for example, can occur immediately or a long time after application, depending on the reaction of the immune system.

Another of the European Chemicals Agency’s considerations about the risks of tattoos is that, when removed with a laser, the substances in the ink are “broken” into smaller particles, which would release the harmful chemicals contained in it to circulate through the body and reach others. tissues and organs, such as lymph nodes or the liver.

This possibility also caught the attention of a group of researchers from the University of Binghamton (USA), who have analyzed the components of different brands of paints sold in the American market.

Brazilian legislation provides that equipment and inks used for tattooing must be registered with Anvisa. Photo: Ritesh Raj/Unsplash

In items from 16 manufacturers, analyzed with an electron microscope, half had particles smaller than 100 nanometers, a size that was classified as “worrying” because of the risk that they cross the cell membrane. According to the researchers, who presented some results at a meeting of the American Chemical Society (ACS) at the end of August, the components contained in the bottles of tattoo ink are “a mystery”.

With almost one hundred paints analyzed, the study identified that, in addition to the very small particles, many contained ingredients that were not listed on the label, such as ethanol, and 26 contained azo compounds (one of the types of substances limited by the European agency). The group of scientists reported that “surprisingly, no manufacturer makes specific pigments for tattoo inks”.

THE Food and Drug Administration (FDA)a regulatory agency in the United States similar to the National Health Surveillance Agency (Anvisa), considers these products a type of cosmetic. Therefore, the agency only intervenes in cases of need to recall batches or contamination of products by microorganisms and claims not to exercise regulatory authority over the pigments used in paints – about 50 currently, in a list that continues to grow.

The agency recognizes that while there are dyes approved for use in cosmetics, none are approved to be injected into the skin. “Using an unapproved dye in a tattoo ink makes the ink adulterated. Many pigments used in tattoo inks are not approved for any kind of skin contact. Some are industrial-grade dyes suitable for printers or car paints.” “, says an FDA fact sheet on tattoos and permanent makeup.

Anvisa and regulation in Brazil

Brazilian legislation provides that equipment and inks used for tattooing must be registered with Anvisa. Today, there are 13 registered inks in the country. The agency informed that it follows the discussions on the safety of tattoo inks in the European Union, but that in Brazil there is no list of prohibited pigments like that of ECHA.

The requirements for Anvisa’s authorization are provided for in resolution RDC 55 of 2008, which classifies items as “products used in the procedure of permanent artificial pigmentation of the skin” and seeks to ensure the absence of toxic or carcinogenic products among the components. registered, the pigments must comply with three resolutions of the health surveillance agency (RDC 185/2001, RDC 546/2001 and RDC 553/2021).

The manufacturing or importing company must be regularized in the National Health Surveillance System (SNVS), have operating authorization for the activity (manufacturing or import) and comply with good manufacturing practices provided for in resolution RDC 665/2022. To demonstrate product safety, biological assessment and risk management reports need to be submitted.

Based on the biological assessment, if Anvisa understands that biocompatibility tests are necessary – which assess the interaction of the substance with the body’s tissues -, the manufacturer must also provide them and submit their reports. The packaging labels, in turn, must contain the ink composition exactly as it was evaluated and approved by Anvisa.

According to dermatologists, the red pigment is responsible for the highest number of allergic reactions. Photo: José Pinto/Unsplash

Is it possible to minimize possible damage?

For Moyses Lemos, who is coordinator of electronic media at the Brazilian Society of Dermatology, the regulation represents an additional security for tattoo artists and clients. “Certainly, if you have an ink that is following Anvisa authorization rules and within the validity period, it is possible to trust a little more. But of course, you still need to take all possible precautions”, he says.

Among these precautions, tattoo artist Esther Gawendo lists studio cleaning and hospital disinfectant stretchers; sanitization of hands; use of disposable materials such as needles, gloves and masks, and use of hospital waste for infectious material such as blood. “The tattoo parlor must follow strict hygiene standards, almost like a medical clinic,” she explains. In addition, the tattoo artist needs to be vaccinated against diseases such as hepatitis B, C and D, covid-19, and tetanus.

Esther is president of the Tattoo do Bem organization, which aims to represent the professional interests of tattoo artists and piercers nationwide and has 1,200 members. Graduated in Nursing, she teaches biosafety courses and is CEO of Tattoo Week, a convention that annually brings together thousands of tattoo artists, piercers and exhibitors.

growing sector

According to data from Brazilian Support Service for Micro and Small Enterprises (Sebrae), the sector grows 25% a year and has more than 150 thousand studios across the country. Esther believes that, as the professionalization of the area increases, the category seeks to invest more in security. “Tattooing has become an important market, which generates income and work, and there is more concern in offering a quality service, based on safety standards and good practices. We have indications that at least 90% of Brazilian tattoo artists use inks national and submitted to Anvisa’s evaluation”, he reports.

During the University of Binghamton study that analyzed the composition of ink brands, researchers said they interviewed tattoo artists about their knowledge of the products used by their clients. They quickly identified a preferred brand, but confessed they didn’t know much about the components involved.

For Esther Gawendo, this type of knowledge is part of the necessary baggage to practice the profession: “It is the tattoo artist’s duty to know the product he uses and all its technical specifications”, she points out.

Lemos adds to the list of care that can make tattoos safer considerations about the colors chosen. He claims that the pigment responsible for the greatest number of allergic reactions is red and that red, orange and yellow paints are more likely to contain carcinogens. Blue, green and silver also require attention, as they contain nickel, a metal often associated with allergies caused by jewelry.

“As a dermatologist, I am against tattooing. But this is a personal thing, tattoos have been done for millennia. People have to take risks. The best, of course, would be to use only black pigment, if they choose to do so. get the tattoo”, he explains.

More than an ancient art form, tattooing has gained more practical applications. “Today, we have safety tattoos for chronic patients (diabetics, hypertensive and allergic, for example), who use it to signal the disease in the body itself. Thus, in case of an accident or fainting, the rescuer knows that that person needs specific care”, exemplifies Esther Gawendo.

Among other applications are covering scars and visually reconstructing eyebrows or nipples lost in cancer treatments, which can help to re-signify brands and restore patients’ self-esteem.

Black pigment is considered less risky when getting a tattoo, according to experts. Photo: Steven Erixon/Unspalsh

Here are tips to minimize the risks when getting a tattoo:

– Check if the ink used by the professional is registered with Anvisa and is within the expiration date;

– Check if the studio is within the health surveillance standards;

– Observe if the tattoo artist is aware of asepsis techniques, sterilizes the environment and uses disposable needles, gloves and mask;

– Avoid colors such as red, green, blue and silver, whose pigments are more likely to cause allergic reactions;

– Follow the post-tattoo guidelines provided by the professional, which include avoiding foods with inflammatory potential, cleaning the tattooed body region and avoiding exposure to sunlight.

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