Tattoos are common in the United States, with 21 percent of adults reporting that they have at least one sample of permanent ink on their skin. The good news for this fifth of the population is that outbreaks of nontuberculous mycobacterial (NTM) skin infections are rare.
NTM infections that are caused by tattoos can range from mild inflammation, such as a rash, to severe abscesses that require surgical removal. When associated with tattoos, there has been evidence that suggests that diluting ink with nonsterile water has caused the infections.
Artists often dilute tattoo ink in order to create custom shades. Some inks are also prediluted by the manufacturer to create a specific color.
A report released by the Centers for Disease Control and Prevention identified outbreaks of NTM in Washington, New York, Iowa and Colorado in 2011-12. These outbreaks appeared to be related to dilution of ink.
In a few cases, the artist used distilled or reverse osmosis water to dilute the ink, assuming that these waters were sterile, which they are not. In other cases the ink had been prediluted by the manufacturer and the pathogens were introduced before sale.
Because tattoo inks are considered to be cosmetics under the Federal Food, Drug and Cosmetics Act, the Food and Drug Administration does not require tattoo inks to be sterile. The CDC does recommend, however, that tattoo ink manufacturers be held to higher product safety standards. It also recommends that consumers contemplating being tattooed use registered tattoo studios, request inks made specifically for tattoos and check that the artist adheres to hygienic standards and processes.
— Breanna Hostbjor, The Bulletin