Tattoo-Associated Viral Infections: A Review

Tattoos, a decorative form of body art, are produced by inoculating pigment into the dermis. Tattoo-associated viral infections can be cutaneous and localized to the tattoo ink; however, viral pathogens acquired during inoculation can cause systemic disease. A comprehensive review of the literature only reveals a limited number of published reports regarding patients with tattoo-associated cutaneous viral lesions. Cutaneous viral pathogens causing lesions to occur on a tattoo include herpes simplex virus (HSV), human papillomavirus (HPV), molluscum contagiosum, rubella, and vaccinia. HPV lesions (45 patients) and molluscum contagiosum (14 patients) are the most frequently reported tattoo-associated viral lesions; nearly all the patients were immunocompetent. HPV lesions included verruca vulgaris (29 patients), verruca plana (14 patients) and human immunodeficiency virus (HIV)-associated acquired epidermodysplasia verruciformis (two men). Hypotheses for tattoo-associated HPV lesions and molluscum contagiosum include a black ink-induced cutaneous immunocompromised district since the viral lesions all occurred in black or dark ink and the use of virus-contaminated instruments, pigment, or both during tattoo inoculation. Other sources of HPV include viral spread from a wart that is present but not associated with the tattoo site or virus transmission from the tattooist resulting from contact with a wart on an ungloved hand or HPV-containing saliva used to thin the pigment. Herpes compunctorum (three patients), vaccinia (two patients), and rubella (one patient) were less commonly reported. Blood borne viral pathogens associated with systemic manifestations - such as hepatitis B, hepatitis C and HIV - have also been acquired during tattoo inoculation; however, health care interventions have been adopted to attempt prevention of viral agent transmission during tattoo acquisition.