Permanent Makeup Isn't Always Pretty

WEDNESDAY, June 27 (HealthDay News) -- Permanent makeup, which is essentially just a tattoo in place of cosmetics such as eyeliner or lipstick, may cause serious problems in some people, particularly those with a history of allergy, a new study suggests.

Ironically, the study found that the very procedures that are supposed to enhance beauty may actually result in unsightly side effects, such as swelling or bumps.

The news isn't all bad, however. Most of the adverse reactions included in the study were caused by a single product line of inks, and those inks were recalled in 2004.

"The Centers for Disease Control and Prevention study confirms that permanent makeup can cause severe health problems in some women," said the study's lead author, Masja Straetemans, a senior epidemiologist at the Robert Koch Institute in Berlin, Germany, who was with the CDC at the time of the study.

"Of the 92 women [included in the study], 89 had used ink shades from the specific company in at least one procedure after June 1, 2003, before the development of health problems," she said, adding that data on the ink used was missing for the remaining three women.

Like a regular tattoo, the permanent makeup procedure injects pigment into a deep layer of skin called the dermis, according to the American Academy of Micropigmentation (AAM). The epidermis is the layer of skin you normally see, and the one that constantly sheds and renews itself. Permanent makeup may also be called cosmetic tattoo or micropigmentation.

According to the AAM, there are many reasons people choose to have cosmetic tattoos, including wanting to save time, having difficulty applying makeup, and thinning eyebrows or eyelashes, among others.

No U.S. government agencies or national organizations track the number of people who undergo these procedures, so accurate estimates on the prevalence of permanent makeup aren't available. The procedure is generally done in a salon or a tattoo parlor, which are regulated by local authorities, not the U.S. Food and Drug Administration. The FDA can, however, regulate the inks used in tattoos and permanent makeup.

And, when the FDA noticed a dramatic jump in the number of adverse events being reported, it began the current study. Between 1988 and 2003, there were only five adverse events from cosmetic tattoos reported to the FDA. But, beginning in 2003, more than 150 people reported problems, according to the study.

Researchers from the FDA and CDC interviewed 92 of the people who reported problems and found that the most common adverse reactions were tenderness, swelling, itching and bumps.

"The body sees the pigment as a foreign body and reacts to it, causing a chronic inflammatory reaction," said Dr. Ellen Marmur, chief of dermatological surgery at Mount Sinai Medical Center in New York City. "The area gets swollen, bumpy and red. It looks like a bad, bumpy scar. It's very unattractive."

Marmur said it's impossible to know ahead of time who will have a reaction and who won't, although most of the people interviewed for the study -- 74 percent -- had a history of allergies. Additionally, the study found that people with allergies took twice as long to heal, on average, Straetemans said.

Sixty-eight percent of the study volunteers were still experiencing a reaction at the time of the study interview, and the duration of symptoms ranged from 5.5 months to three years.

According to Straetemans, 89 of the 92 study participants had been injected with ink from a single product line. That line of inks was recalled by its manufacturer, Premier Products in Arlington, Texas, in September 2004, according to the FDA.

Marmur said she believes people underestimate the risks involved with these types of procedures, especially the most common one: dissatisfaction with the way the tattoo looks. "People need to know the cost of reversing a tattoo is often more than getting it," she said, and that's only for tattoos that can be removed, because not all can.

Another concern, Marmur said, is the potential for serious infections, such as hepatitis. "You don't know if the needles are safe, and if they're not sterilized, they can introduce bacteria and viruses under your skin. Even your own bacteria that live on your skin can be a problem if the skin isn't cleaned properly."

If you do decide on a cosmetic tattoo, Marmur suggests asking for a list of ingredients in the inks so you can check with your dermatologist to see if there's anything likely to cause a reaction. Also, your dermatologist can let you know if that particular ink can be removed at a later date. Some red inks, which could be used in a lipstick tattoo, turn black and become permanent if they're exposed to the lasers commonly used to remove tattoos, she said.

What's most important, Marmur said, is to make sure you know the worst-case scenarios. "You should know the common and rare side effects before doing anything, and you should know if it's something that can be reversed if you're not happy with the results. Also, ask if there's any way to allergy test in advance."

More information

The U.S Food and Drug Administration has more information on permanent makeup and tattoos.

SOURCES: Masja Straetemans, Ph.D., senior epidemiologist, Robert Koch Institute, Berlin, Germany; Ellen S. Marmur, M.D., chief, dermatological surgery, Mount Sinai Medical Center, New York City; June 28, 2007, New England Journal of Medicine