With almost one in every five Americans now sporting at least one tattoo, the U.S. Food and Drug Administration (FDA) has issued a new consumer alert on potential health risks associated with these permanent markings.

According to the latest FDA Consumer Update, there has been an increase in the number of people reporting infections from contaminated tattoo inks as well as bad reactions to the ink themselves.

Linda Katz, M.D., M.P.H., director of FDA’s Office of Cosmetics and Colors, is advising consumers to “think before you ink”.

“While it’s true that you can get infections from unhygienic practices and equipment that isn’t sterile, in the last several years there have been cases in which people got infections because the ink itself was contaminated with microorganisms, such as bacteria and mold introduced either at the time of manufacture or at the tattoo parlor. Using non-sterile water to dilute the pigments is a common culprit, although not the only one,” the update informs.

Make sure that your tattoo artist uses sterilized equipment. They will usually make a show of opening tattoo machine needles that are prepackaged in pre sterilized containers. If you don't see this or you have your doubts be sure to ask. If you are not comfortable get out.

The problem is that there’s really no way of knowing if the ink being used is safe. Even if ink containers are sealed or wrapped and the manufacturer label says the product is sterile, the ink can still be contaminated. And some of it is!

“There are reports in the published scientific literature of tattoo inks that contain everything from pigments used in printer toner to pigments used in car paint,” the report cites.

Do-it-yourself tattoo kits are also problematic and have been associated with infection or allergic reaction to a pigment or diluent used in the creation of the ink.

Reactions to contaminated ink are numerous. It could show up as a rash, redness, or bumps in the area of the tattoo or the person could develop a fever. Because tattoos are permanent, the reaction may persist.

“Serious infections can require months of treatment with a variety of antibiotics," the report states. "More virulent or aggressive infections may be associated with high fever, shaking, chills, and sweats. If these symptoms arise, you may need antibiotics, hospitalization and/or surgery.”

For those who do suffer a reaction, the first thing to do is get appropriate medical care.

Second, notify the tattoo parlor so that the establishment can identify the ink used and avoid using it again. They can also give you detailed information on the brand, color, and/or batch information to further pinpoint a defective product.

Third, notify the FDA. This can be done online or by calling 1-800-FDA-1088.

Long-term effects of the ink and/or possible contaminants in the ink are still unknown.

Also being investigated are the impacts of tattoo removal, which is usually done with laser treatments. The short- or long-term consequences of how pigments break down after laser treatment is still unknown although permanent scarring has been known to occur.

The bottom line is to “think before you ink!”

“Because of all the unknowns described above, this is not a decision to be made without careful consideration,” the guidelines suggest. “If you do decide to get a tattoo, make sure the tattoo parlor and artist are in compliance with all state and local laws. The National Conference of State Legislatures has a Web page on state laws, statutes and regulations governing tattooing and body piercing."

Consumers can also check on local regulations by contacting the county or city health department.