Letters Infections from tattooing

Outbreak of Mycobacterium chelonae in France

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5483 (Published 26 October 2010) Cite this as: BMJ 2010;341:c5483
  1. Joana Goldman, doctor1,
  2. François Caron, PhD, department of infectious diseases2,
  3. Julie de Quatrebarbes, doctor1,
  4. Martine Pestel-Caron, PharmD, department of microbiology2,
  5. Philippe Courville, doctor1,
  6. Martin Xavier Doré, doctor3,
  7. Damien Picard, doctor1,
  8. Anne-Bénédicte Duval-Modeste, doctor1,
  9. Pierre Bravard, doctor4,
  10. Pascal Joly, professor1
  1. 1Department of Dermatology and INSERM U905, Rouen University Hospital, University of Rouen, Rouen, France
  2. 2Groupe de Recherche sur les Antimicrobiens et les Microorganismes, UPRES EA 2656 (GRAM, IFR 23), Rouen University Hospital, University of Rouen, Rouen, France
  3. 3Dermatology Centre, Rue du Marechal Joffre, Le Havre, France
  4. 4Department of Dermatology, Le Havre General Hospital, Le Havre
  1. Pascal.Joly{at}chu-rouen.fr

Tattooing is common worldwide.1 Various infections have been reported, including local infections mainly due to pyogenic bacteria and systemic infections such as hepatitis B and C and HIV.2 3 We report a large outbreak of Mycobacterium chelonae skin infection occurring in France over eight months that was related to contaminated ink.

Forty eight patients presented with skin lesions, mainly pustules, occurring from 3 to 35 days after tattooing by two different tattooists in Le Havre, France. Lesions were located in areas tattooed with diluted black ink (figure).


Clinical lesions of tattooed patient. Note that papules and pustules are located only in black and grey areas

Histological analysis showed granulomas in half of the cases. A strain of M chelonae grew from skin samples of 13 out of 30 patients (43%). Forty one patients were successfully treated with clarithromycin, which was combined with tobramycin in 10 patients. Seven patients were not given antibiotics initially, of whom six healed spontaneously.

Black inks came from manufacturers in large bottles. The tattooists had poured the ink into smaller flasks, using it either undiluted or diluted with saline, serum, or tap water to obtain shades of grey. Syringes were also rinsed with tap water. M chelonae grew in samples from the two bottles previously used for tattooing. In contrast, no contamination was observed in a bottle that remained unsealed until analysis. No further infected patients were referred after the tattooists changed their procedures.

Two outbreaks of atypical mycobacteria occurring one to three weeks after tattooing have recently been reported in the United States and France.4 5 Lesions were also located only in the grey areas of the tattoos. Skin infections of atypical mycobacteria might be underestimated because of failure to detect them by routine analysis. These outbreaks emphasise the need for tattooing regulation to guarantee hygiene and safety. Improvement of safety procedures and information to tattooists and customers might help to prevent these complications.


Cite this as: BMJ 2010;341:c5483


  • Competing interests: None declared.


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