Safety of tattoos and permanent make-up : adverse health effects and experience with the Council of Europe Resolution (2008)1

In the last decades, the proportion of the tattooed population has been increasing all over the world, particularly in the young generations. Concerns about the possible health problems associated to tattoos and permanent make up (PMU) have also grown together with the number of tattoo/PMU applications and removals. The Council of Europe Resolution (CoE ResAP)(2008)1 [1], on requirements and criteria for the safety of tattoos and permanent make-up, is a non-binding internationally recognised benchmark that was taken as a reference for the development of national legislation adopted in a number of European countries. The European Commission launched the 18-month project "Tattoos - Permanent Makeup" with the aim of collecting data about the use, the ingredients, the European Union (EU) market and the possible health problems associated to tattoo and permanent make-up inks. This project is divided into 4 Work Packages: 1) preparatory work; 2) state of play; 3) assessment and update of the CoE ResAP(2008)1; 4) conclusions. The reports on Work Packages 1 and 2 [2, 3] are available at http://bookshop.europa.eu/. The present report is the outcome of Work Package 3 which aims to gather data about adverse health effects and complications linked to tattoo/PMU application and/or removal, risk perception and communication, data gaps and research needs, as well as to evaluate the lessons learned from the experience in implementing the recommendations of the CoE ResAP(2008)1. The information was collected through the following sources. (1) Two questionnaires were developed: one addressed to dermatologists on adverse health effects and the other one to national authorities on complications, experience with the CoE ResAP(2008)1, risk perception and communication, data gaps and research needs. They were sent to all EU Member States and European Free Trade Association (EFTA) countries and to 36 dermatologist associations in Europe with the request to circulate among their members. 14 Member States and 19 dermatologists filled-in the questionnaires. (2) A systematic review of the literature from 2003 on was carried out according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta- Analysis) methodology. (3) The outcome of the meetings of the Consumer Safety Network Subgroup Tattoos and Permanent Make-up was taken into account.