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Self-reported side effects of tattooing: a cross-sectional study in the Swedish TABOO cohort
Emelie Rietz Liljedahl1, Thomas Rustemeyer2, Anna Saxne Jöud1,3
1Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University Faculty of Medicine, Lund, Sweden.
Introduction:
Tattooing is common in many populations, yet population-based data on side effects remain limited. We aimed to describe the occurrence of self-reported acute- and delayed-onset side effects following tattooing and investigate individual and tattoo-related determinants in a Swedish population.
Methods:
The Swedish Tattoo and Body Modifications Cohort includes 13 049 participants, of whom 2633 reported having at least one tattoo and constituted the study sample. In 2021, participants reported predefined acute (within 1 month) and delayed (after 1 month) side effects following tattooing using a structured questionnaire. Information on educational attainment and yearly disposable income was obtained through linkage to national registers. Multivariable logistic regression was used to identify determinants of reporting any acute- and delayed-onset side effects.
Results:
Overall, 40% of participants reported at least one acute-onset side effect and 10% reported a delayed-onset side effect following tattooing. A larger tattooed body surface area (>5 hand palms), compared with <1 hand palm, was associated with higher odds of both acute- and delayed-onset side effects (OR 1.81, 95% CI 1.13 to 2.90 and OR 2.06, 95% CI 1.04 to 4.10, respectively). Use of coloured inks, compared with black ink only, was also associated with increased odds of side effects. Acute-onset side effects were associated with younger age, a low-melanin, highly photoreactive skin phenotype, cosmetic tattooing and more tattoo sessions, whereas delayed-onset side effects were most strongly associated with prior acute-onset reactions (OR 8.17, 95% CI 5.45 to 12.20, compared with no acute-onset side effects). Healthcare-seeking for delayed-onset side effects was uncommon.
Conclusions:
Acute- and delayed-onset side effects following tattooing were common and associated with individual characteristics and tattoo-related factors. Delayed-onset side effects were strongly associated with prior acute-onset reactions, while healthcare-seeking was uncommon. These findings indicate that a substantial proportion of tattoo-related side effects never reach the healthcare system, highlighting the importance of population-based studies for assessing their occurrence and determinants.
