Adverse effects related to tattoos in the community setting: A systematic review

Background: Tattoos were historically associated with deviant behaviours or religious and other social purposes, but in the last decades, they have gained increasing popularity and have become a mainstream. The aim of this systematic review is to assess the literature evidence about decorative tattoos complications, considering both infective and non-infective risks. Methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. We searched the following electronic bibliographic databases: PubMed, Scopus and Web of Science (science and social science citation index). Results: The literature search resulted in 6473 studies. A total of 207 full articles were considered potentially relevant and were reviewed independently by researchers. After full-text evaluation, 152 of 207 articles were excluded, as they did not meet selection criteria. The remaining 55 studies were included in the systematic review and their quality assessment was performed. Ten studies reported microbiological complications, 37 reported non-microbiological effects and eight reported either microbiological and non-microbiological complications. Conclusions: Several well-known and uncommon risks are associated with tattooing and tattoo after-care. Public health authorities could take into account health education programmes for tattooists and customers in order to prevent health complications in people with tattoos. PROSPERO registration number: CRD42020177972