Tattoos and permanent make-up (PMU) gain increasing popularity among the general population. There are indications that pigments or their fragments may translocate within the body, however knowledge about possible systemic adverse effects related to tattoos is very limited. We investigated the prevalence of systemic chronic health effects including cardiologic diseases, cancer and liver toxicity and their relationship with the presence and characteristics of tattoos and PMU as part of the LIFE-Adult-study, a population-based cohort study. The control group without tattoos was from the same cohort and adjusted for confounders based on age, sex, smoking-status, body mass index, alcohol consumption and socioeconomic status. Of 4,248 participants, 7.4% (n=320) had either a tattoo (4.7%; n=199) or a permanent make-up (3.1%; n=135), or both (n=14). Thereof 5% (16/320) reported medical complications in relation to their tattoos or PMUs. Regarding systemic chronic health effects, increased odds ratios among the tattooed population were found for cardiologic diseases and liver toxicity. For non-melanoma skin cancer, results from the tattoo questionnaire gave no indication for any tumour development at the site of the tattoo. Our results demonstrate an increased risk for cardiologic and liver effects in participants bearing a tattoo. Strong differences in the observed effects between men and women point on the presence of a sex-specific bias. Even if no statistically robust conclusion can be drawn due to the small sample size, the results suggest that cardiologic outcomes and liver toxicity in tattooed individuals should be investigated further using prospective designs in larger cohorts.

The authors have declared no competing interest.

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The responsible ethics board at the Medical Faculty of the University of Leipzig approved the study (reference: 86 LIFE Adult - 263-2009-14122009).

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