Someone I know and love has recently had another tattoo etched (or is it drawn?) over their left shoulder, the most recent of at least 16 tattoos that I know about, about their person. Perhaps, it is a symptom of growing older but there seems to be more and more people in more walks of life with tattoos. I have a number of unanswered questions about tattoos:
- Why exactly do people get tattoos?
- Just how many people get tattoos these days?
- Do just young people get tattoos?
- Are there associations with tattoos that we make as doctors?
- Are these associations in fact a form of prejudice against those who choose to decorate their body permanently with ink figures, symbols and pictures?
Although the cultural significance to young people in the UK today of tattoos may be a subject for sociologists to ponder I find it interesting to consider the relationship of the tattoo with medicine. The prevalence of tattoos is perhaps something for our public health colleagues to consider but I do wonder if my perception of it is accurate?
In order to try to answer my questions I carried out a brief search of the NCBI database  for articles including the words “prevalence” and “tattoo”, or “perception” and “tattoo” or with the MESH term “Tattooing/psychology” as applied to humans and in the English language. This non-exhaustive, but handy search revealed approximately 50 publications since I graduated as a doctor 7 years ago and began taking notice of tattoos.
Of these only 3 were carried out in the UK. One was a touching anecdote about a patient who tattooed the name of his rare medical condition onto his body , another was about the effect of tattoos on body image and self-perception of the recipient . The same author had carried out research which closest answers one of my questions 4 years earlier when a study of 160 undergraduates resulted in the provocatively titled article “Unattractive, promiscuous and heavy drinkers: perceptions of women with tattoos” .
Since I have graduated it seems that tattoos are no longer confined to rock stars, sailors, soldiers and drug addicts. Even watching football highlights over the last few years has made me realise that more and more people younger than me are getting tattoos, and more elaborate and extensive tattoos at that.
It seems a shame that the only recent piece of research in the UK draws on the opinion of university students and comes up with such a negative connotation of tattoos . I wonder if this feeling pervades amongst the medical profession? Do we use phrases such as “tramp stamp” – a derogatory term for a tattoo in the lumbar region that seems popular, especially amongst women? Do we associate tattoos, perhaps wrongly with increased risks of blood borne viruses, where the majority of the research seems to focus?
If one is to rely on the evidence base about tattoos, you could be led to believe that doctors perception of those with tattoos are those with risky behaviour, certain occupations, with hepatitis B/C or some other weird and rare disease contracted from Chinese ink . Our older patients fall into the categories of criminal or regretful.
My search didn’t really answer my questions, but made me examine myself. It made me examine what I thought of people with tattoos, questioning whether my observations of ink-stained flesh slip into judgements and whether there is anything I could do to change this, if that were the case. I also realised that there is a massive gap in knowledge about tattoos. If tattoos are a risk factor for both physical and psychological illness, then perhaps we should at least have a handle on who is getting tattoos, where they’re getting them, why they are getting them and how it affects us as doctors when we see and treat them.
- Pubmed. http://www.ncbi.nlm.nih.gov/pubmed/ [accessed 8 June 2012]
- Whittaker RG, Turnbull DM, 2009. A diagnostic tattoo. Clin Genet. 75(1):37-8.
- Swami V, 2011. Marked for life? A prospective study of tattoos on appearance anxiety and dissatisfaction, perceptions of uniqueness, and self-esteem. Body Image. 8(3):237-44.
- Swami V and Fyrnham A, 2007. Unattractive, promiscuous and heavy drinkers: perceptions of women with tattoos. Body Image 4(4):343-52.
- Hamsch C, Hartschuh W, Enk A, Flux K, 2011. A Chinese tattoo paint as a vector of atypical mycobacteria outbreak in 7 patients in Germany. Acta Derm Vernereol. 91(1):63-64.