The red parts of the man’s tattoo became inflamed

University Centre of General Dermatology and Oncodermatology, Wroclaw Medical University

A Polish man had an extreme allergic reaction to red ink in a tattoo on his arm, causing all his hair to fall out, his sweat glands to shut down, and his skin to develop vitiligo. The case adds to growing concerns about the effects of some modern tattoo inks on the immune system.

Tattooing is an ancient practice, and for most of its history, it was performed using black soot-based inks that were slowly inserted into the skin using hand techniques. Nowadays, colourful synthetic tattoo inks can be quickly introduced into large areas of skin using electric tattoo machines.

Many of the dyes in coloured tattoo inks were originally developed for printer inks and car paints, rather than the human body. In recent years, there have been increasing reports of allergic reactions to coloured tattoo inks, particularly in people with underlying immune conditions such as eczema, asthma or coeliac disease. One survey found that 6 per cent of people who get a tattoo have a reaction that lasts for more than four months, most commonly if it contains red ink.

The Polish man’s reaction began about four months after he had a large multicoloured tattoo inked on his forearm. He became intensely itchy and developed a red rash over his whole body. He also gradually lost all the hair on his head and body, his nails turned yellow, his lymph nodes became swollen, and he lost the ability to sweat. After two years of these symptoms, he also began to develop large patches of vitiligo, a skin-lightening condition.

The man, who is in his thirties, saw dermatologists, allergy specialists, endocrinologists, neurologists, ophthalmologists and internal medicine specialists, but no one could figure out what was going on. Eventually, a reaction to red ink in his tattoo was suspected, since the red flower and flame motifs in the design looked swollen. A biopsy of a swollen lymph node in his groin also revealed traces of the red ink, which had migrated from his skin.

With limited treatment options available, the man had to have eight surgeries to cut out the red-inked sections of his tattoo and replace them with skin grafts. Since then, his hair has grown back and his vitiligo has stopped progressing. However, he still can’t sweat due to permanent damage to his sweat glands. This puts him at risk of heat stroke, meaning he had to resign from his military job and must regularly spray his body with water.