 |
2,500 yr. old tattoo on the
arm of a mummy.[18]
|
MAYBE it’s just me (it’s
probably just me) but having had a few surgeries in my life, there exists within me a remote fear that one day I will need to go for an MRI and only then—as the
metallic device tears through my skin—will I find out that during one of those surgeries,
something was left inside me.
The fear, although distant, is nonetheless present
enough that recent headlines containing some variation of: ‘MRI’s causing
tattooed skin to burn’, caught my attention.
However, having now delved a bit deeper into this subject, it seems the consensus is that the probability of this occurring (as something more than a transient skin irritation) is about as remote as my fear of
leftover surgical devices tearing through my skin—okay, well, perhaps not quite that
remote, but it should probably not rank on the list of worries keeping you awake at night.
The take away message from the first part of what follows below is: if you have a tattoo and need to go for an MRI,
mention it to your doctor so that together you can discuss and decide upon the
best options before proceeding.
***
 |
| MRI |
MAGNETIC RESONANCE IMAGING (MRI) is a technique that uses a magnetic field and radio waves to
create detailed images of the organs and tissues within your body. Most MRI machines
are large, tube-shaped magnets. When you lie inside an MRI machine,
the magnetic field temporarily realigns hydrogen atoms in your body.[1]
The rationale behind
the concerns about tattoos and MRI’s is that ink pigments containing iron (or
any metallic substance) is/are susceptible to the magnetic fields used in
MRI machines. This is why people with implants containing metallic parts
cannot receive MRI’s.[3]
The ferromagnetic properties of certain inks used tattoos and cosmetics has been
described in various journals.[7][8][9][11][12][13][15]
The first report of an
MRI-induced reaction to a patient’s skin containing a tattoo was described by
Kredstein et al. in 1997.[7][10]
The patient in that report
experienced sudden burning pain in the area of an abdominal tattoo in
the presence of a static magnetic field upon entrance into the MRI suite.[7][10]
As the patient later elected to have the tattooed skin excised, the authors were able to confirm a ferromagnetic property of the tattoo pigment by documenting its migration toward a magnet.[7][10]
The authors went on to demonstrate that iron
oxide–based pigments were displaced by a
magnetic field, whereas carbon-, titanium-, and copper-based pigments were
unaffected.[7][10]
In one of two cases described in 2000, first degree burns were reported on the skin of a patient in the area of a tattoo with several loops in its design.
One proposed explanation was that the conductive pigment in the loops may have induced an electric current, "and thus burned the skin following the radio-frequency pulse of the MRI process."[7][10][14][15][23]
One proposed explanation was that the conductive pigment in the loops may have induced an electric current, "and thus burned the skin following the radio-frequency pulse of the MRI process."[7][10][14][15][23]
In the second reported case, a patient undergoing MRI sustained a second-degree burn in the right
deltoid, in the region of a tattoo, but the skin reaction only occurred in the sections of the tattoo where there the ink contained dark pigment.[7][14][15]
The supplier of the
tattoo ink was contacted, and it was discovered that the dark tattoo ink
contained high concentrations of iron oxide.[7][10]
A 2002 study,
obtained data from 1032 surveys distributed to clients of cosmetic tattoo
technicians asking for information about—among other things—their experiences
during MRI procedures.[2][7]
135 (13.1%) of study
subjects underwent MRI after having permanent cosmetics applied. Of these, 2
individuals (1.5%) experienced problems associated with MR imaging.
One subject reported a sensation of “slight tingling” and the other subject reported a sensation of “burning”; both sensations did not last long.[2][7]
One subject reported a sensation of “slight tingling” and the other subject reported a sensation of “burning”; both sensations did not last long.[2][7]
TATTOOS & INFECTIOUS DISEASES
Tattoos are created by using
needle(s) to inject ink into a person's skin. The needle penetrates the
skin by about a millimeter and deposits a drop of insoluble ink into the skin
with each puncture.[4]
Since any puncture
wound has the potential for infection and disease transmission, tattoos carry
several risks.[4][6]
If the equipment used
to create your tattoo is contaminated with infected blood, you can contract
various blood-borne diseases — including tetanus, syphilis hepatitis B and
hepatitis C.[4][6][17]
The use of unsterilized
tattoo equipment or contaminated ink can also transmit surface infections of
the skin and fungal infections.[18][20]
In amateur tattooing,
such as that practiced in prisons, there is an elevated risk of infection.[18][20]
According to the Centers
for Disease Control and Prevention (CDC), there have been no documented
cases of HIV transmission from a tattoo.[4][6][18][19]
TATTOOS AND ALLERGIES
Tattoo dyes —
especially red, green, yellow and blue dyes — can cause allergic skin reactions, such as rashes at the tattoo site. This can occur even years after you get the
tattoo.[16][17]
That said, allergic
reactions to tattoo pigments are rare.[16]
Although the pigments
used may have U.S. Food and Drug Administration (FDA) approval for other
purposes, the FDA does not regulate tattoo inks.[4]
TATTOOS & BLOOD DONATION
The risk of infection
is why the American Association of Blood Banks requires a one-year wait between
getting a tattoo and donating blood.[16]
The American Red Cross will not accept blood from
someone who has been tattooed in the past year unless the tattoo parlor is
state-regulated. Most states do not regulate tattoo parlors.[4]
Canadian Blood Services defers donors who have had a tattoo or body piercing for six months because of the infectious risks associated with crossing the skin barrier.[6]
Several things to keep in mind when considering your tattoo artist
and establishment:
To kill all
disease-causing organisms, all needles need to be properly sterilized using an autoclave.[6][4]
Instruments and
supplies that can't be autoclaved — including drawer handles,
tables and sinks — should be disinfected with a commercial disinfectant or
bleach solution after each use.[17]
A fresh pair of gloves
should be worn for each procedure to protect skin from possible contaminants.[4][6][17]
If tattoo ink is poured
into a disposable container for use in the tattoo gun, it must not be returned
to the original container after use.[4][6]
TATTOOS & THE IMMUNE RESPONSE
When the needle
punctures the skin, the body’s inflammatory response sends immune system cells racing
to the site of the wound.[5]
Macrophages flood the
wound site and attempt to clean up the dye and the inflammation it is causing.[5]
The remaining dye gets
soaked up by fibroblasts. The fibroblasts, along with many of the macrophages, then
remain suspended in the dermis, projecting the dye through the skin.[5]
Sometimes granulomas (nodules) will form around material that the body sees as foreign, such as tattoo pigment.[5][16]
Keloids—scars that grow beyond normal boundaries when you injure or traumatize your skin—may form after a tattoo.[16]
Sometimes granulomas (nodules) will form around material that the body sees as foreign, such as tattoo pigment.[5][16]
Keloids—scars that grow beyond normal boundaries when you injure or traumatize your skin—may form after a tattoo.[16]
 |
Approximate times of the different phases of wound healing, with faded intervals marking substantial variation. [22] |
Pre-laser tattoo
removal methods included dermabrasion, salabrasion (scrubbing the skin
with salt), cryosurgery, and excision—which is sometimes still used
along with skin grafts for larger tattoos. These older methods,
however, have been nearly completely replaced by laser removal treatment
options.[18][21]
***
Fin
UPDATES / RELATED
What Happens When You Get An Infected Tattoo, And How To Drain It / Medical Daily / September 10, 2015Tattoo Artist Vinnie Myers Restores Nipples For Women Who Have Lost Them To Breast Cancer; Here's Some Of His Best Work / Medical Daily / July 17, 2015
Woman's Tattoo Mistaken For Cancer on Imaging Test / LiveScience / June 8, 2015
Tattoo Care: Many People With Tattoos Experience Some Long-Term Medical Complications / Medical Daily / May 27, 2015
Student Alex Falkenham Creates Tattoo Removal Cream That Fades Body Art For As Little As A Dollar Per Square Inch / Medical Daily / Feb. 18, 2015
Fresh Ink: Mummified Iceman Has New Tattoo / Livescience.com / Jan. 28 2015
REFERENCES:
[1] www.mayoclinic.org/tests-procedures/mri/basics/definition/prc-20012903
Tope, W. D. and
Shellock, F. G. (2002), Magnetic resonance imaging and permanent cosmetics
(tattoos): Survey of complications and adverse events. J. Magn. Reson. Imaging,
15: 180–184. doi: 10.1002/jmri.10049
Wilson, Tracy V..
"How Tattoos Work" 01 April 2000. HowStuffWorks.com.
<http://health.howstuffworks.com/skin-care/beauty/skin-and-lifestyle/tattoo.htm>
04 January 2015.
The Secret to a
Tattoo's Permanence: The Immune System
The dye gets lodged
deep in the skin thanks to hungry anti-inflammatory cells called macrophages.
OLGA KHAZANJUL 22 2014,
10:52 AM ET
[8] 1. Jackson JG,
Acker JD. Permanent eyeliner and MR imaging. AJR Am J Roentgenol.
1987;149:1080.[PubMed]
[9] 2. Kanal E,
Shellock FG. MRI interaction with tattoo pigments. Plast Reconstr
Surg. 1998;101:1150-1151[PubMed]
[10] 3. Kreidstein
ML, Giguere D, Freiberg A. MRI interaction with tattoo pigments: case
report, pathophysiology, and management. Plast Reconstr Surg.
1997;99:1717-1720 [PubMed]
[11] 4. Lund G,
Wirtschafter JD, Nelson JD, Williams PA. Tattooing of eyelids: magnetic
resonance imaging artifacts. Ophthalmic Surg. 1986;17: 550-553 [PubMed]
[12] 5. Nakamura
T, Fukuda K, Hayakawa K, et al. Mechanism of burn injury during magnetic
resonance imaging (MRI): simple loops can induce heat injury. Front Med
Biol Eng. 2001;11:117-129 [PubMed]
[13] 6. Sacco DC,
Steiger DA, Bellon EM, Coleman PE, Haacke EM. Artifacts caused by
cosmetics in MR imaging of the head. AJR Am J Roentgenol.
1987;148:1001-1004 [PubMed]
[14] 12. Wagle WA,
Smith M. Tattoo-induced skin burn during MR imaging. AJR Am J
Roentgenol. 2000;174:1795. [PubMed]
[15] 13. Weiss RA,
Saint-Louis LA, Haik BG, McCord CD, Taveras JL. Mascara and eyelining
tattoos: MRI artifacts. Ann Ophthalmol. 1989;21:129-131 [PubMed]
[17] http://www.mayoclinic.org/healthy-living/adult-health/in-depth/tattoos-and-piercings/art-20045067?pg=2
[20] "Tattoos:
Risks and precautions to know first". MayoClinic.com. 2012-03-20.
[21] Images
of Tattoo removal procedure
[22] http://en.wikipedia.org/wiki/Wound_healing
[23] Vahlensieck M. Tattoo-related cutaneous
inflammation (burn grade I) in a mid-field MR scanner. Eur Radiol. 2000;10:197.
[PubMed]
IMAGE CREDITS:
"Scythian tatoo". Licensed under Fair use via Wikipedia - http://en.wikipedia.org/wiki/File:Scythian_tatoo.jpg#mediaviewer/File:Scythian_tatoo.jpg
"MRI-Philips" by Jan Ainali - Own work. Licensed under CC BY 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:MRI-Philips.JPG#mediaviewer/File:MRI-Philips.JPG
"Tattoo artist with latex gloves" by Giovanni Gallucci from Plano, Texas ('burb of Dallas), USA - Cat Tattoo - Addison, Texas - Z' Online Marketing Tips. Licensed under CC BY 2.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Tattoo_artist_with_latex_gloves.jpg#mediaviewer/File:Tattoo_artist_with_latex_gloves.jpg
"Wound healing phases" by Mikael Häggström.When using this image in external works, it may be cited as follows:Häggström, Mikael. "Medical gallery of Mikael Häggström 2014". Wikiversity Journal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 20018762. - Own work (from the template Logarithmic time scale - milliseconds to years.svg). Licensed under Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Wound_healing_phases.png#mediaviewer/File:Wound_healing_phases.png
"Ricardo Montalban Herve Villechaize Fantasy Island 1977" by ABC Television - eBay itemphoto frontphoto back. Licensed under Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Ricardo_Montalban_Herve_Villechaize_Fantasy_Island_1977.JPG#mediaviewer/File:Ricardo_Montalban_Herve_Villechaize_Fantasy_Island_1977.JPG
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