{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T09:35:19Z","timestamp":1793180119832,"version":"4.5.0"},"reference-count":50,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"abstract":"<jats:p>Tattooing injects pigments into the dermis, creating intradermal chemical exposure that can trigger delayed inflammatory reactions and, in some cases, systemic immune manifestations. About 32% of US adults report at least 1 tattoo, highlighting the need for prevention and accurate counseling. This topical review summarizes tattoo ink\u2013associated harms and outlines US policy and research priorities. We synthesized regulatory documents and selected literature, including the Modernization of Cosmetics Regulation Act (MoCRA), US Food and Drug Administration (FDA) guidance and safety communications on tattoo inks, Council of Europe resolutions, and the European Union Registration, Evaluation, Authorization, and Restriction of Chemicals (EU REACH) restriction. We screened reference lists for additional sources to link clinical risk signals to actionable policy levers. Despite ink\u2019s persistence in tissue, in the United States, federal oversight largely follows a cosmetic framework, while local regulation emphasizes studio hygiene. Recent US regulatory changes, including MoCRA and FDA guidance on tattoo contamination, strengthen postmarket authority and contamination control but still lack enforceable composition limits for intradermal, long-term exposure. Key gaps include inconsistent ingredient disclosure, limited batch\/lot traceability, and the absence of a national tattoo adverse event registry. By contrast, EU REACH pairs chemical restrictions with labeling that supports ingredient transparency and batch identification. Priorities include enforceable composition limits, standardized disclosure with batch traceability, and a clinician-led registry to improve signal detection and patient counseling. Clinicians can support these reforms by documenting tattoo exposures, reporting suspected ink-related adverse events, and engaging professional societies to inform regulators and shape practical standards.<\/jats:p>","DOI":"10.1177\/00333549261464870","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:54:51Z","timestamp":1785740091000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Tattoo Ink as a Chronic Intradermal Chemical Exposure: A Policy and Research Agenda for US Regulation"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6696-5069","authenticated-orcid":false,"given":"Gerardo","family":"Guilarte","sequence":"first","affiliation":[{"name":"Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9670-7775","authenticated-orcid":false,"given":"Miriam","family":"Motlak","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nana-Hawwa","family":"Abdul-Rahman","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7897-2542","authenticated-orcid":false,"given":"Sonal","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/acupmed-2013-010320"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)12242-0"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1159\/000369175"},{"key":"e_1_3_2_5_2","unstructured":"Schaeffer K Dinesh S. 32% of Americans have a tattoo including 22% who have more than one. Pew Research Center. August 15 2023. Accessed December 17 2025. https:\/\/www.pewresearch.org\/short-reads\/2023\/08\/15\/32-of-americans-have-a-tattoo-including-22-who-have-more-than-one"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.2788\/177900"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1159\/000452148"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(11)70340-0"},{"key":"e_1_3_2_9_2","unstructured":"US Food and Drug Administration. Tattoos temporary tattoos & permanent makeup. Updated October 15 2024. Accessed December 17 2025. https:\/\/www.fda.gov\/cosmetics\/cosmetic-products\/tattoos-temporary-tattoos-permanent-makeup"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1159\/000369231"},{"key":"e_1_3_2_11_2","unstructured":"Council of Europe. Resolution ResAP(2008)1\u2014resolution on requirements and criteria for the safety of tattoos and permanent make-up. Adopted February 20 2008. Accessed December 17 2025. https:\/\/search.coe.int\/cm?i=09000016805d3dc4"},{"key":"e_1_3_2_12_2","unstructured":"European Chemicals Agency Committee for Risk Assessment Committee for Socio-economic Analysis. Opinion on an Annex XV dossier proposing restrictions on substances used in tattoo inks and permanent make-up. 2019. Accessed May 25 2026. https:\/\/echa.europa.eu\/documents\/10162\/dc3d6ea4-df3f-f53d-eff0-540ff3a5b1a0"},{"key":"e_1_3_2_13_2","unstructured":"European Chemicals Agency. Tattoo inks and permanent make-up (REACH restriction from January 2022). 2022. Accessed December 17 2025. https:\/\/echa.europa.eu\/hot-topics\/tattoo-inks"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60215-X"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.14498"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13020503"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1159\/000369645"},{"key":"e_1_3_2_18_2","unstructured":"van der Bent SAS. Tattoo Complications: Diagnosis and Treatment. PhD thesis. Vrije Universiteit Amsterdam; 2021. Accessed March 18 2026. https:\/\/research.vu.nl\/en\/publications\/tattoo-complications-diagnosis-and-treatment"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1205114"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-11721-z"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1159\/000468149"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2510392122"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/2050313X20936036"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.15070"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.12093"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13092"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13908"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/0961203319867395"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.5826\/dpc.1404a230"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12425"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1159\/000292627"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1159\/000535536"},{"key":"e_1_3_2_33_2","unstructured":"US Food and Drug Administration. 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