Mark V. Dahl, MD


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In This Article

Abstract and Introduction


Consider infection when rash develops in a tattoo.


Tattooing inks may be contaminated with infectious agents. An epidemic of cutaneous Mycobacterium chelonae infections occurred in Rochester, New York, in the fall of 2011. Data obtained for analysis included interviews with patients, histopathological analysis of skin biopsy specimens, acid-fast bacteria smears, microbial cultures, antimicrobial sensitivity testing, DNA sequencing, pulse-field gel electrophoresis, cultures of ink, assessment of source water and faucets at tattoo parlors, and investigations of the ink manufacturer.

Within 3 months, 19 persons (13 men) developed a "rash" in their new tattoos associated with the "painting" of grey tattoos by a single tattoo artist. The tattoo parlor utilized "best practices," using sterile instruments, disposable gloves, ink from single-use containers, and providing appropriate aftercare. M. cheloniae was isolated in 14 patients and confirmed by DNA sequencing. Investigations implicated a premixed ink as the infecting media. Organisms were isolated from the grey tattoo inks obtained not only from this tattoo parlor but also from unopened bottles from the manufacturer. Antimicrobial sensitivities were similar in the two patients tested; the organisms were sensitive to clarithromycin, doxycycline, and linezolid.