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Adverse effects related to tattoos in the community setting: a systematic review
  1. Alessandro Sindoni1,
  2. Federica Valeriani2,
  3. Francesca Gallè3,
  4. Giorgio Liguori3,
  5. Vincenzo Romano Spica2,
  6. Matteo Vitali1,
  7. Carmela Protano1
  1. 1 Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy
  2. 2 Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
  3. 3 Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, Naples, Italy
  1. Correspondence to Francesca Gallè, Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, Naples, Italy; francesca.galle{at}


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.

  • allergy and immunology
  • infections
  • prevention

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  • Contributors AS, FV, FG and CP operated the selection of the articles and the extraction of data, and wrote the manuscript. GL, VRS and MV supervised the review process and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.