What Tattoos Really Do To Our Body’s Immune System



I lie on the mat of the open-air bungalow in Apia, Samoa, watching a gecko. As his cock twitched, I felt a sympathetic twitch in my leg. Su’a Sulu’ape Paulo III, the sixth-generation Samoan tattoo artist, leaned over me, pausing to see if my movement was due to pain.

I had been in Samoa for a month, studying Samoan tattoo culture and the impact of large traditional pieces called pe’a and malu – tatau in general – on the immune system. Now I was getting my own hand-typed leg tattoo, albeit considerably smaller.

This field season was the fourth of my research into the relationship between tattooing and immune response. My first study focused on a small sample, mostly women, in Alabama. What I had observed in this group suggested that tattooing could help boost the immune response.

But a small study in the United States proved nothing, despite headlines that said tattoos could cure the common cold. Good science means finding the same results over and over and then interpreting them to understand something about the world.

That’s why I traveled in 2018 with fellow anthropologist Michaela Howells to the Samoa Islands. Samoans have a long and continuous history of heavy tattooing. Working with contemporary machine and hand tattoo artists in American Samoa, we wanted to see if we would find the same link to an improved immune response.

Over 30% of Americans are tattooed today. Yet few studies have focused on biological impact beyond cancer or infection risks.

The tattoo creates a permanent image by inserting ink into tiny perforations under the top layer of skin. Your body interprets a new tattoo as an injury and reacts accordingly, in two general ways.

Innate immune responses involve general reactions to foreign bodies. So, getting a new tattoo triggers your immune system to send white blood cells called macrophages to eat invaders and sacrifice themselves to protect against infection.

Related: Getting your lover’s name tattooed has been a bad idea for hundreds of years

Your body also initiates what immunologists call adaptive responses. Proteins in the blood will try to fight off and disable specific invaders that they recognize as problems. There are several classes of these proteins – called antibodies or immunoglobulins – and they keep circulating in the blood, waiting not to encounter that same invader again. They are ready to launch a rapid immune response next time.

This adaptive capacity of the immune system means that we could measure immunoglobulins in saliva as proxies for previous stress caused by tattooing.

In American Samoa, Howells and I worked at the Office of Historic Preservation to recruit study participants with the help of tattoo artists Joe Ioane of Off Da Rock Tattoos, Duffy Hudson of Tatau Manaia and traditional tattoo artist Su’a Tupuola Uilisone Fitiao. Our sample of 25 tattooed people included both Samoans and island tourists.

We collected saliva at the beginning and end of each tattoo session, controlling the duration of the tattoo. We also measured recipients’ weight, height, and fat density to account for health. From the saliva samples, we extracted the antibody immunoglobulin A, as well as the stress hormone cortisol, and the inflammatory marker C-reactive protein. Immunoglobulin A is considered a first-line immune defense and offers important protections against common pathogens such as those of the common cold.

By comparing the levels of these biomarkers, we determined that immunoglobulin A remains higher in the blood even after the tattoos have healed. Additionally, people spending more time under the tattoo needle produced more salivary immunoglobulin A, suggesting an increased immune response to receiving a new tattoo compared to those with less or no tattoo experience. This effect seems to depend on receiving multiple tattoos, not just how long it’s been since you received one. This immune boost can be beneficial for other skin lesions and for overall health.

Related: Can a tattoo be removed?

The tattoo seems to exert a priming effect: that’s what biologists call it when naïve immune cells are exposed to their specific antigen and differentiate into antibodies that remain in the blood for many years. Each tattoo prepares the body to respond to the next.

Other studies show that short-term stress benefits the immune system. Stress’s bad reputation stems from chronic forms that really undermine immune response and health. But a little is actually good for you and prepares your body to fight germs. Regular exercise provides immune function benefits through repetition, not necessarily single visits to the gym. We think it sounds like how every tattoo seems to prepare the body for alertness.

Our Samoan findings supported the results of my first study in Alabama. But of course, correlation does not imply causation. An improved immune response correlates with a greater tattoo experience, but perhaps healthier people heal easily from tattoos and enjoy having more of them. How would we know if getting a tattoo could actually improve a person’s health?

Samoans have the oldest continuous tattoo culture in the Pacific Islands. Although many Samoans complain that young people get tattoos for fashion, most lead them to honor their heritage, saying that their tattoo does not belong to them but to Samoan culture.

Samoans generally obtain family permission to receive pe’a and malu. Getting and wearing these tattoos involves many responsibilities and indicates a willingness to serve one’s community.

Several of the Samoans in our sample had little interest in getting other tattoos, and one even said he was afraid of needles. They get pe’a and malu for the significance of these tattoos to their cultural identity, not because they are fashionable ways to show off. Samoan social expectations mean that getting pe’a or malu is less about motivated fashion choices and more about getting a tattoo in the United States. That’s why Samoa is a great place to find out if the immune bump we see after tattooing is due to healthier people going under the needle in the first place – in Samoa, people of all body types and from all walks of life get them, from priests to politicians.

Related: Five life lessons from the immune system

In July 2019, I focused on collecting several biological samples from people getting tattoos extensively in Apia, where they are administered daily in the city center. I collected about fifty saliva samples from ten participants which will be analyzed in the coming year by the anthropologist immunologist Michael Muehlenbein.

Tattoos can provide visual evidence that others are approaching to identify healthy companions or sturdy friends. Such fitness signals have been compared to the tail feathers of the peacock, which would be too heavy if the peacock were not vigorous enough to escape predators.

Even in the modern environment with improved healthcare, tattoos can “raise the bar” by artificially injuring the body to demonstrate health. In a study I conducted of almost 7,000 undergraduate students, male intercollegiate athletes in general and football players in particular were more likely to be tattooed than non-athletes and less likely to suffer from tattoo-related medical issues than tattooed non-athletes.

It’s unclear whether the benefits of tattooing are significant enough to make a clinical difference to health, so don’t expect a new tattoo to undo a diet of cheeseburgers and fries. But there is no doubt that the tattoo is associated with tenacity and that we humans influence each other through impressions as much as through reality.


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