Heavy Metal Content in Tattoo and Permanent Makeup Inks and European Standards-Is There Still a Health Risk?

Tattoos and permanent makeup involve intradermal pigment deposition and may introduce toxic trace elements into the body. Despite increasing popularity, harmonized EU regulations on tattoo ink composition only came into force in 2022 under REACH. This study evaluated the chemical safety of 41 commercially available inks in the EU following the implementation of these restrictions. Twelve heavy metals were analyzed (Cd, Pb, As, Hg, Zn, Cu, Ni, Cr, Co, Sb, Se, Mn). Copper showed the highest concentrations (mean 1751 mg/kg; max 25,701 mg/kg), while cadmium was lowest (mean 0.13 mg/kg). Exceedances of EU limits were recorded for Ni (24 samples), As (20), Cr(VI) (16), Cu (10), Sb (8), Co (6), and Pb (5); mercury was not detected in any ink. Dermal exposure was modeled across three tattooing scenarios using SED, MoS, HQ, and LCR indicators. Unacceptable non-cancer risk (MoS < 100) was mainly associated with copper (up to 85.4% of products), with additional concerns for zinc and arsenic (~50% of samples in higher-use scenarios). HQ values > 1 were most frequent for Ni, Cr(VI), and Cu, affecting up to 68.3%, 43.9%, and 58.5% of inks, respectively. Lifetime cancer risk above 1 × 10^-4 was observed for nickel in several products. Despite recently tightened European regulations, a substantial share of inks remains non-compliant and may pose carcinogenic and non-carcinogenic health risks, underscoring the need for continued market surveillance and enforcement.