As a good parent, you had the talks about sex, alcohol, drugs, eating disorders, etc., with your college-bound teenager. But did you have the tattoo talk? There is more to think about than just appearance issues. When done right, tattoos don’t present too much of a health risk, but they’re not risk-free. Some of the hazards may surprise you.

Question: What are the risks of getting a tattoo?

Answer: For permanent tattoos or permanent makeup, the process is much the same and the risks are similar. The most common concern is becoming infected with bacteria or viruses when tattoo needles are not properly sterilized. This even could lead to hepatitis or HIV infections. Some people have allergic reactions to various tattoo ink pigments, so it is sometimes recommended that people with significant allergy problems avoid getting tattooed. Unwanted scar tissue can form from getting or removing a tattoo. People can experience swelling or burning in a tattoo when they undergo magnetic resonance imaging (MRI), but this is generally just temporary and not a reason to avoid a needed MRI. Always mention the tattoo to the MRI technician.

Q: Is tattooing regulated?

A: Although the U.S. Food and Drug Administration is the national regulatory agency for cosmetics, it does not approve any tattoo pigments for injection into the skin and does not regulate tattoo shops. It does monitor problems reported about tattoos and permanent makeup. For example, earlier this month the agency issued a warning about bacterial contamination of inks recalled by the manufacturer A Thousand Virgins.

Licensing of tattoo artists and tattoo shop permits is handled at the state level. Hawaii has specific sanitation regulations for tattoo shops and the initial licensing of tattoo artists requires passing a test on bloodborne pathogens and blood tests for tuberculosis and syphilis. Hawaii requires tattoo shops to be well-lighted and ventilated, have walls, ceilings and floors that are easily cleaned, proper storage cabinets for tattooing supplies, no-smoking signs, and hand-washing sinks for tattoo artists.

In Hawaii, it is illegal to tattoo anyone who is intoxicated and anyone under 18 years old without parental consent.

Q: Can tattoos be removed?

A: Yes, but it can be painful and can require up to 10 treatments. The FDA has approved certain laser devices for tattoo removal, but yellow, green and red are more difficult to remove than darker colors such as black and dark blue.

The FDA does not approve do-it-yourself tattoo removal creams because these may cause skin rashes, chemical burns or scars.

If you want to remove a tattoo, seek out a physician who is highly experienced in tattoo removal.

Q: Are there characteristics of a reliable tattoo shop?

A: At the minimum, a tattoo shop should be well-lit and clean. If not, find another shop. State regulations also require specific hand-washing sinks for tattoo artists, proper cabinets for tattooing equipment and supplies, and no-smoking signs, among other things.

To help make good decisions on tattooing, go to the FDA’s website at www.fda.gov and search "tattoos."

Alan Titchenal, Ph.D., C.N.S., and Joannie Dobbs, Ph.D., C.N.S., are nutritionists in the Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii-Manoa. Dobbs also works with University Health Services.