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Background: Millions of people are tattooed. However, the frequency of health problems is unknown., Methods: We performed an Internet survey in German-speaking countries., Results: The provenance of tattooed participants (n = 3,411) was evenly distributed in Germany. The participants had many (28%; >4) and large tattoos (36%; >or=900 cm(2)). After tattooing, the people described skin problems (67.5%) or systemic reactions (6.6%). Four weeks after tattooing, 9% still had health problems. Six percent reported persistent health problems due to the tattoo, of which females (7.3%) were more frequently concerned than males (4.2%). Colored tattoos provoked more short-term skin (p = 0.003) or systemic (p = 0.0001) reactions than black tattoos. Also the size of tattoos and the age at the time of tattooing play a significant role in many health problems., Conclusions: Our results show that millions of people in the Western world supposedly have transient or persisting health problems after tattooing. Owing to the large number and size of the tattoos, tattooists inject several grams of tattoo colorants into the skin, which partly spread in the human body and stay for a lifetime. The latter might cause additional health problems in the long term., (Copyright 2010 S. Karger AG, Basel.)