Madam, tattooing is done by inserting exogenous pigments and/or dyes using sharp instruments into the dermis to permanently mark the body. Mostly, tattooing is done for expression of one\\\'s individuality and for cosmetic, memorial and  cultural purposes. Hence, young people can be most predisposed to tattooing due to the characteristic immaturity, curiosity, risk-taking attitude and inclination toward peer-pressure.
Although tattooing has been more common in the west; it is now also penetrating in other parts of the world. Pakistan can deeply inculcate the tattooing practices as 30% of the population is between 15-29 years¹ that is of young people who have maximum vulnerability to get predisposed to tattooing. Second; there is influence of western-culture through media. Hence; as was anticipated, the rising trend of tattooing is recently reported in Pakistan.²
With such a rise in tattooing practices worldwide; more literature is available on health issues that result from tattooing. Infections, allergic reactions, dermal complications, haematomas, inflammation of lymph nodes are documented health-effects, with complications being more common in larger coloured tattoos. Globally; tattooing is reported as common mode of transmission of numerous infectious diseases. A case-controlled study from Pakistan reported that tattooing increases the risk of Hepatitis C by more than 27 times.⁴
Tattooing also interferes with imperative medical procedures, for example, metal particles (particularly iron-oxide) in tattoo pigments interact with magnetic fields during MRI (Magnetic Resonance Imaging) procedures to cause burns.⁴ Tattooing also interferes with diagnosis of melanomas. This is due to discolouration and inflammation of lymph nodes in tattooed people.⁵
Along with the medical aspect; there are also religious and social aspects of tattooing. Opinion regarding tattooing among different societies and religions is diverse. Most of the religions forbid making modifications in Almighty\\\'s creation (human body) through tattooing. In some societies bearing a tattoo depicts criminal behaviour. In Japan, tattoos are strongly associated with crime organizations known as the Yakuza.
Due to the devastating health and social aspects of tattooing; the practice should be curtailed. For this; we recommend multi-faceted interventional strategy to increase awareness regarding the hazards of tattooing:
* Sessions should be organized by academic institutions
* Media in collaboration with health care providers should organize programmes.
Lastly, Ministry of Health should take measures regarding the hygiene standards at tattooing parlours to lessen the risk of transmission of infectious diseases.
 
Maryam Sanaullah, Ambreen Pardhan, Sanaullah Bashir
Medical Students, Dow Medical College, Dow University of Health Sciences, Karachi.
Corresponding Author: Maryam Sanaullah.
Email: mariamtariq27@hotmail.com

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2. Ghulam Muhammad. Tattoos culture in Pakistan. 28th September 2010. (Online) (Cited 2011 Nov 28). Available from URL: http://blogs.aaj.tv/2010/09/tattoos-culture-in-pakistan/.
3. Ghias M, Pervaiz MK. Identification of epidemiological risk factors for hepatitis C in Punjab, Pakistan. J Ayub Med Coll Abbottabad 2009; 21: 156-61.
4. Ratnapalan S, Greenberg M, Armstrong D. Tattoos and MRI. AJR 2004; 183: 541.
5. Chikkamuniyappa S, Sjuve-Scott R, Lancaster-Weiss K, Miller A, Yeh IT. Tattoo pigment in sentinel lymph nodes: a mimicker of metastatic malignant melanoma. Dermatol Online J 2005; 11: 14.