Time to think about the ink: Why tattoo geography and regulation matter in clinical dermatology

Tattooing is now mainstream, with around one in four young European adults tattooed. Dermatologists increasingly encounter allergic, lichenoid, granulomatous, and photoallergic reactions, as well as pigment migration. These cannot be interpreted without considering tattoo geography. Regulatory frameworks differ: EU REACH restricts many pigments, while post-Brexit UK law still permits some. Identical findings may therefore reflect different exposures and reporting duties. Routine history taking should include where, when, and which colour tattoos were obtained - improving diagnosis, counselling, and pharmacovigilance.