Sir, inner lip inking is on the rise as a latest trend in body art with the lower labial mucosa being tattooed. Popular on blogs, this tattoo is considered unique as it is not readily visible. It is an extremely painful procedure and can be expensive too. Figure 1 shows a 31-year-old male who had such a tattoo done by a tattoo artist because he thought it was trendy. Figure 2 shows a 35-year-old male who had the tattoo completed for devotional reasons by a temple worker.

Figure 1
figure 1

A 31-year-old male with a lip tattoo

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Figure 2
figure 2

A 35-year-old male who had a lip tattoo completed for devotional reasons

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Tattoos play an important role in many religions as ritual tools and part of tradition; in particular Buddhism and Hinduism use them extensively for protection and devotion. Ramnaamis are a sect of Hindus in North India who devoutly and uniformly tattoo their entire body including the tongue and inside of the lips, believing that it protects them from harm. Tattooing rituals are also common to tribes of South East Asia and sacred Buddhist texts are commonly tattooed by Thai people. These texts are believed to possess powers and magical potency.1 The trend of tattooing the inner surface of the lip with these sacred texts as part of ritual is now on the rise.

Due to the action of saliva most of these tattoos may fade away within a few months but some may stay up to five years;2however, they pose serious health risks such as: infection, swelling, granuloma formation and scarring.3 Intraoral tattoos may have an additional risk of gingival recession around the lower anteriors that are in contact with the tattoo.2

Tattoo inks contain many components including metallic salts, carbon, aluminium, oxygen, azo pigments and polycyclic compounds.4 The local and systemic carcinogenic potential of tattoos remain unclear, being described in literature as purely coincidental.4 There are reported cases of malignancy arising from cosmetic tattoos of the lips, but none from the oral mucous membrane.5,6The US Food and Drug Administration has not approved any tattoo pigments for injection into the skin and many pigments used in tattoo inks are industrial-grade colours suitable for printers' ink or automobile paint.2 Despite this, faith and fashion seems to be driving popularity. While a counterargument is that tattoos have been practised for a long time, the issue is how they will behave in the oral mucosa and we need to keep a close watch on these cases while also educating our patient about their potential risks.