Red tattoo ink causes man to lose all his hair and stop sweating
The red parts of the man’s tattoo became inflamed
University Center for General Dermatology and Oncodermatology, Medical University of Wroclaw
A Polish man had an extreme allergic reaction to red ink from a tattoo on his arm, causing all of his hair to fall out, his sweat glands to shut down and his skin to develop vitiligo. The case adds to growing concerns about the effects of some modern tattoo inks on the immune system.
Tattooing is an ancient practice, and for most of its history it was performed using black, soot-based inks that were slowly inserted into the skin using manual techniques. Nowadays, colored synthetic tattoo inks can be quickly introduced onto large areas of skin using electric tattoo machines.
Many colorants in colored tattoo inks were originally developed for printer inks and automotive paints, rather than for the human body. In recent years, more and more cases of allergic reactions to colored tattoo inks have been reported, especially in people with underlying immune conditions such as eczema, asthma or celiac disease. A survey found that 6% of people who get a tattoo have a reaction that lasts more than four months, most commonly if it contains red ink.
The Pole’s reaction began about four months after he got a large, multi-colored tattoo on his forearm. He was itching intensely and developed a red rash all over his body. He also gradually lost all the hair on his head and body, his nails turned yellow, his lymph nodes became swollen, and he lost the ability to sweat. After two years of symptoms, he also began developing large patches of vitiligo, a skin-lightening disease.
The man, aged around 30, consulted dermatologists, allergists, endocrinologists, neurologists, ophthalmologists and internal medicine specialists, but no one could figure out what was happening. Eventually, a reaction to the red ink in his tattoo was suspected, as the patterns of red flowers and flames in the design appeared puffy. A biopsy of a swollen lymph node in his groin also revealed traces of red ink that had migrated from his skin.
With limited treatment options, the man had to undergo eight surgeries to cut out the red ink sections of his tattoo and replace them with skin grafts. Since then, his hair has grown back and his vitiligo has stopped progressing. However, he still cannot sweat due to permanent damage to his sweat glands. This puts him at risk of heat stroke, meaning he has had to resign from his military job and must regularly douse his body with water.
Dermatologists at Wroclaw Medical University in Poland, who oversaw the man’s treatment, were unable to obtain a sample of red ink from his tattoo artist for testing. However, in other cases of allergic reactions to red-colored tattoos, ink testing has identified the presence of synthetic organic dyes called azo dyes.
The reason tattoo ink sometimes triggers health problems is because it chronically activates the immune system. Most tattoo ink stays in the skin, but some travels to the lymph nodes, which are part of the immune system. There, immune cells called macrophages capture the ink and try to eliminate it, but they fail because the ink particles are too large. When a macrophage dies, it passes the captured ink to a new one, thus establishing a perpetual cycle. “The immune system is constantly trying to do something against this ink, which triggers a chronic immune response,” explains Signe Clemmensen from the University of Southern Denmark.
The Pole suffered from a pre-existing autoimmune disease called Hashimoto’s disease that may have made his immune system particularly sensitive, his dermatologists said in a report documenting his case. As a result, her immune system may have started to wrongly attack her skin.
Growing research shows that even people without immune problems sometimes experience long-term adverse effects from tattoos. Clemmensen’s research, for example, showed that having a tattoo of any color triples the risk of developing lymphoma, a cancer affecting the lymph nodes.
In January 2022, after the Pole got the tattoo, the European Union attempted to make tattooing safer by limiting some chemicals commonly used in tattoo inks, including azo dyes. However, other jurisdictions have yet to follow suit.
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