Getting inked has become even more popular over the last few decades. Rachel Zammit Cutajar says making sure the practitioner of your choice has a licence is fundamental to ensuring these risky services remain safe.

If you think you’ve seen more and more tattoos on different people over recent years, you’re probably right. Tattoos have gone through a bit of a renaissance over the last couple of decades. 

Since the dawn of Instagram in 2010, Americans seeking out tattoos has almost doubled. In 2015, one in three had at least one tattoo. Just three years earlier, it was one in five. And the fact that Malta has its own tattoo convention suggests that the Maltese are following this global trend.

Since the beginning of time, humans have felt the urge to mark their bodies in a way that was different from others. Otzi, the prehistoric iceman, who lived between 3400 and 3100BC and was found, well-preserved, in the ice and snow of the Italian Alps in 1991, had 61 tattoos on his body. 

Over the years, the reason people got tattoos differed around the world, particularly in the past. In Japan, criminals were tattooed either on the arms or the face, though this practice died out when decorative tattoos came into fashion and criminals started covering up tattoos. 

In the US, it was generally sailors who got tattoos with different images marking achievements at sea. For example, a swallow indicated a sailor had completed 5,000 nautical miles at sea, which was no mean feat at the time, and a tattoo of a ship indicated they had been around Cape Horn.

Indigenous tribes, particularly of the Pacific Islands, used tattoos to identify members of their group. For example, if a person had a tattoo of indigenous plants on their skin, it acted as a type of address. 

Today, people get tattoos for a number of reasons, including attention, self-expression, artistic freedom, rebellion, a visual display of a personal narrative, reminders of spiritual/cultural traditions, sexual motivations, addiction, identification with a group, or even drunken impulsiveness.

Tattoos are, indeed, a form of self-expression, with research showing links with managing depression as well as self-image. However, they also carry a number of risks as, fundamentally, the skin is punctured and ink is injected into it.
In fact, any service where the skin is punctured – think dentistry, semi-permanent make-up and even acupuncture – can result in the transmission of blood-borne viruses. So, making sure the practitioner of your choice has a licence is fundamental to ensuring these services remain safe. 

The decision to get a tattoo should not be taken lightly for a number of reasons, not least because the design is permanent. [Though 78 per cent of Americans are happy with their tattoos, some do regret it.]

Most importantly, the health risk associated with getting tattoos should also be considered before a decision is taken. Tattoos are done using a sewing-machine-like instrument that pierces the top layer of the skin and injects tiny droplets of ink into the holes where it remains permanently. As a result of this breach of the top layer of the skin, infection can occur.

Allergies to the inks can also occur, especially with red, green, yellow and blues, while scarring and the development of keloids [a raised surface that occurs when scarring happens too quickly] may also develop. Infections could be passed on through equipment that is not properly sterilised and can include blood-borne infections like methicillin-resistant Staphylococcus aureus [MRSA), hepatitis B and C and HIV. 

So how do you ensure the tattoo artist you have selected is going to provide a service that is safe? 

The Health Care Standards Directorate inspects and licenses tattoo artists and their studios to ensure they provide safe services. There are currently over 150 licensed tattoo artists in Malta and Gozo.

Patricia Galea, director within the Health Care Standards department, says “some people see health regulation in their industry as an unnecessary burden, however, the inspection team does its utmost to establish a collaborative relationship with licensees so that the highest standards are met. 

“Most applicants are happy to comply with our standards and regulations, while those who do not meet 100 per cent of the checklist are given guidelines and assistance until they are fully compliant and granted a licence.”

To get a licence, an establishment, such as a tattoo parlour, semi-permanent make-up studio, dental, acupuncture, or podiatry clinics, must adhere to current regulations; ensure that all staff are qualified, registered and vaccinated against blood-borne viruses; that cleaning procedures and sterilisation processes are adequate; and all equipment used is CE marked. 

In the case of tattoo parlours, the inks used are checked to ensure they are valid and not expired and are not among those that are known to have presented some form of adverse reaction.

Over the last four years, nine establishments have had their licences temporarily withheld until they updated their practices and were compliant with the latest standards. However, Patricia is mostly concerned about the places that practice without a licence and are not reported.

“It is very important that the public is aware that the establishments are inspected and licensed through the Directorate and the advantages of opting to get a service from a licensed establishment. A list of these is available on www.deputyprimeminister.gov.mt”

Perhaps the tattoo industry has begun what Patricia calls “self-regulation”. Clients are requesting that tattoo artists are licensed, therefore, professionals will seek out a licence before the Directorate has them on their radar. 

Tattooist talk

Guy Lee has been operating as a tattoo artist, both in the UK and Malta, for 15 years and has been on the frontline of this huge increase in people seeking out their own individual brand of ink. 

Though in the past, tattoos were associated with particular types of people – sailors, criminals and biker gangs – today, people from all walks of life are getting inked, he notes. 

“There has been a dramatic increase in people getting tattooed,” Guy acknowledges. “The people that come through my parlour doors range from locals to foreigners either living in Malta or here on holiday. They are from a broad spectrum of ages ranging between 18 to over 85,” he says. 

Guy believes that regulation is important. “It is a necessary procedure to ensure a basic standard is held in the premises and that public health is respected as we are working in an environment that is exposed to blood-borne pathogens and it is important that establishments like ours are not the cause of transfer of such diseases. 

“Getting a tattoo shouldn’t be a dangerous game and adhering to the rules simply ensures safety.”

In the past, the art of tattooing could be taught by anyone with a licence. Today, amendments have been made to the law to ensure that people teaching others how to tattoo are licensed as instructors. This requires them to have been working in a licensed parlour for at least five years and to follow all the protocols stipulated by the new requirements.

A licensed tattoo instructor, Guy says this new approach is highly welcomed. “The purpose of this is to try to eradicate poor quality and reduce risks involved in the tattoo industry here in Malta. 

“Teaching the practice of hygiene is the foremost priority in such a profession that deals with blood-borne pathogens and it involves great care and understanding. 

“We have a nurse who ensures the best possible procedures are not only adhered to but also understood by students in our studio environment. I am renowned among my students to be a strict teacher when it comes to their safety and that of their potential clients.”

The decision to get a tattoo is generally not taken lightly, he maintains, and people tend to do quite a bit of research into the design they want as well as the artist they wish to use. After all, a mistake in artist selection could mean you are left with an unattractive permanent mark on your skin, even if the practice is safe. 

Taking tattoo precautions

Sarah Scicluna, 28, got her first tattoo at the age of 18 and has a total of 25, mostly on her arm, but also on her legs. For her, it is important that a tattooist is licensed, and she generally sticks to the same artist she knows has a licence. 

“I generally stick to the same tattoo artist, Rebecca Bonaci, because I like her style. I know her establishment is licensed, so I never needed to ask to see credentials. However, if I were to use someone else, I would definitely check that they were operating out of a licensed parlour. It’s not worth the repercussions of a dirty needle.”

Not just tattoos

It is not only tattoo artists that can put public health at risk. The Health Care Standards Directorate regulates a number of industries such as dentistry, physiotherapy, podiatry, X-ray clinics, medical diagnostic laboratories, blood establishments, body piercers, semi-permanent make-up artists and acupuncture. 

“We monitor any services that could put public health at risk. 
A dentist using equipment that has not been sterilised could be the cause of transfer of blood-borne disease, which then has a multiplier effect as that person may then go on to spread it. A diagnostic lab giving the wrong results to patients may also be a threat to public health.”

Though clients are likely to seek out the services of a registered dentist, not that many customers looking for services like semi-permanent make-up and acupuncture are likely to ask if their service provider has a licence. At the time of writing, there were just six licensed acupuncture clinics, though many Chinese massage centres as well as physiotherapists will offer unlicensed services. 

“The risks to both personal and public health are the same as the skin is being punctured and blood-borne pathogens can be transmitted if they are not operating according to infection control protocols,” Patricia warns. 

Looking for a licensed practitioner or an approved tattoo instructor? Check which tattoo artists, dentists, physiotherapists, body piercers, acupuncturists, semi-permanent make-up artists and diagnostic labs are licenced at www.deputyprimeminister.gov.mt

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Take care of your tattoo

Once you have selected a licensed artist and are sure about the design, there are several steps you can take to be certain your tattoo heals properly and to reduce the chances of infections:

Keep the skin clean

As obvious as this sounds, keeping the skin clean is vital to keeping infection at bay. Use plain soap and water and avoid direct streams of water on the tattooed area. Be gentle when washing and gently pat dry rather than rub.

Use a gentle moisturiser

Apply a mild moisturiser several times a day.

Avoid sun exposure

Keep the tattooed areas out of the sun for at least a few weeks. Burning newly tattooed skin may cause the area to blister, peel and crack. Even with old tattoos, sunblock is a good idea as the UV rays cause the ink to fade and change shape.

Avoid swimming

Stay out of the water, particularly pools that may have waterborne infections floating around.

Be careful with clothing

Try to select loose clothing that will not stick to the tattooed area.

Allow yourself to heal

Healing should take around two weeks. Don’t try and hurry it up by picking at the scabs as this will only increase the risk of infection and can damage the design and cause scarring.

This article first appeared in Pink Magazine