Dangerous makeup: Eyebrow tattoo infections

Girly confession: I love makeup. I cannot get through an airport in Asia without hitting the cosmetics kiosks. I spent a half-day in Paris last summer tracking down a cult eyeshadow shade. I once lured every woman in my newsroom into testing long-wearing lipsticks against caffeine, pizza and a workout in the building’s gym.

But for all my obsession, I’ve never been interested in permanent makeup. Partly that’s because I love the process — the brushes, the textures, the ritual — as much as the results. Probably also I feared poor technique: I know how hard it is to draw a perfect cat’s-eye, but if I make a mistake, I can wipe it off and try again. And I imagined there were infection risks, though the few papers in the medical literature focus on mistakes and dissatisfaction more than they do on bad bugs.

Turns out that last was a reasonable fear. A new paper in Clinical Infectious Diseases describes a cluster of infections in Switzerland among women who had their eyebrows improved with tattooing: 12 developed infections with Mycobacterium haemophilum, 10 required surgery, and 9 required excision not only of an eyebrow but also all or part of a parotid gland — the big salivary gland in front of the ear through which a major facial nerve travels.

The women came into the infectious-disease practice of the Centre Hospitalier Universitaire Vaudois in Lausanne over 8 months, starting in April 2009. They all had the same symptoms: From two to seven weeks after getting their tattoos, they developed rashes and pustules at the site where they had been inked, followed by pain and swelling in the parotid nearest the infected eyebrow. (Weirdly, the paper says each woman had only one eyebrow infection, as though they were not tattooed on both sides of the face at the same time.) The glands in eight of the 12 abscessed, and 7 developed a fistula, meaning the infected gland started draining through their skin. (That looks like this.)

M. haemophilum is a tough bug; like its distant relative M. tuberculosis, it requires a multi-drug cocktail that can last for weeks. The women took antibiotics for two months without much success before the doctors decided surgery was necessary, and at least three months afterward. Seven of them had to stop or switch drugs during their treatment, for side effects that ranged from white blood cell suppression to elevations in liver enzymes to rashes and nausea.

When the physicians looked for what connected the women, they discovered that they had gotten their tattoos in different studios, but all from the same artist, who freelanced around the area. When they tracked her down, they found that she was following all the correct infection-prevention procedures, though she no longer had the equipment she had used when the women’s infections developed. When they tested her inks, though, they found DNA from M. haemophilum in some of them. Because that bacterium tends to live in water, they hypothesized she had diluted her inks with tap water that was locally contaminated.

The tattoo artist told them that, during the time the 12 women developed infections, she had done permanent makeup on about 400 women. She hhad no way, though, of tracking those clients down.

I think I’ll stick to Lancome.

Cite: Giulieri S, Morisod B, Edney T et al. Outbreak of Mycobacterium haemophilum Infections after Permanent Makeup of the Eyebrows. Clin Infect Dis. (2011) 52 (4): 488-491. doi: 10.1093/cid/ciq191



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