Letters | China’s tattoo ban for footballers rightly highlights the health risks of inking

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The decision by China’s General Administration of Sport to significantly restrict tattoos among football players is medically prescient. A 2013 study found that tattooing is associated with hepatitis C infection, even among those without traditional hepatitis C risk factors such as intravenous drug use and blood transfusion before 1992. Hepatitis B and HIV can also be spread through tattooing.

The ink used in tattooing is also of concern. A paper published in the New England Journal of Medicine in 2012 confirmed an outbreak of tattoo-associated Mycobacterium chelonae skin and soft-tissue infections in Rochester, New York. In 2019, the Food and Drug Administration in the United States issued a warning to consumers, tattoo artists and retailers “of the potential for serious injury from use of tattoo inks that are contaminated with bacteria” after microbiological analysis of tattoo inks identified six inks contaminated with bacteria harmful to human health.

Tattoo ink typically comprises a mixture of many chemicals, including preservatives, viscosity regulators, solvents and several pigments. One of the preservatives found in some inks is formaldehyde, which the International Agency for Research on Cancer classifies as a carcinogen. A 2021 study found that 73 per cent of the 127 US tattoo inks examined tested positive for formaldehyde release.

A European Commission study looking at the safety of tattooing noted that “more than 60 per cent of [the colourants in use] are azo-pigments, some of which can release carcinogenic aromatic amines”. A 2016 Australian government report on tattoo inks in the country found that red and yellow tattoo inks in particular contained azo-colourants.