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MIAMI BEACH -- Almost a third of people with tattoos regretted the decision to get body art, particularly men who obtained tattoos at a young age, a survey of more than 500 tattoo owners showed.

Overall, 31% of survey respondents expressed regret about their tattoos. Men were almost twice as likely as women to regret their tattoo decisions, and the proportion of men with regrets was three times higher among those who got their first tattoo before age 16.

Women, who accounted for almost half of the survey population, consistently expressed less regret, particularly women who got their first tattoo after age 21, Arif Aslam, MBBCh, and Caroline Owen, MBChB, reported in a poster presentation at the American Academy of Dermatology meeting.

"A significant number of people regret having a tattoo, and the longer they have had one, the more likely this becomes," concluded Aslam and Owen, of the Royal Blackburn Hospital in Blackburn, England.

"We feel that this should become an important health message, as tattoo removal is not freely available, and unwanted tattoos can affect life chances and cause significant psychological morbidity."

Interestingly, only about half of people who regretted their tattoos said they would have the art removed if they could, Aslam and Owen added.

The popularity of tattoos and other forms of body art has grown dramatically in recent years. A survey in England showed that 20% of adults have at least one tattoo.

England has more than 1,500 tattoo parlours, and the business continues to expand. In contrast, tattoo-removal services are not as widely available, a fact that individuals should take into consideration when deciding to get a tattoo, Aslam and Owen noted.

To learn more about tattoo owners and the decision-making processes involved with tattoos, the investigators distributed a questionnaire to more than 600 patients who were found to have tattoos during routine skin examinations in the dermatology service of a large district hospital in England. All participants were at least 16 years old.

The survey elicited information about the age at first tattoo, whether the tattoo was produced by a professional or amateur artist, length of time since the first tattoo, total number of tattoos and their location on the body, whether patients still liked the tattoos, whether they regretted their tattoos, and whether they would have tattoos removed if they could.

Questionnaires were returned by 615 patients, 35 questionnaires were excluded because of incomplete data, leaving 580 for evaluation. The study population consisted of 300 men and 280 women, and almost half of the patients were older than 40.

The investigators identified a total of 1,975 tattoos on the patients. Almost half the patients (47%) had two to five tattoos, and 31% had more than five tattoos. The most common tattoo locations were arms (40%), back (25%), abdomen (15%), and head and neck (15%).

Aslam and Owen reported that 45% of the patients acquired their first tattoo between the ages of 18 and 25.

Overall, 213 of the 580 expressed regret about their tattoos, including 143 of 300 men (48%) and 70 of 280 women (25%, P<0.001 versus men).

The results showed a statistically significant relationship between age at first tattoo and regret (P=0.025). Patients who acquired their first tattoo before 16 were most likely to regret the decision (76 of 139, 55%).

The proportion of individuals with regrets decreased as age at first tattoo increased: 87 of 240 (36%) who were 17 to 20 when they got their first tattoo, 49 of 191 (26%) who were 21 to 40, and 3 of 10 (30%) who were 40 or older.

People who regretted their tattoos had the art significantly longer than people who had no regrets (median 18 years versus 12, P=0.001).

The overwhelming majority of people had tattoos applied by professional tattoo artists (87%), and they were significantly less likely to regret their tattoos compared with people whose tattoos were done by amateurs (32% versus 66%, P=0.001).

Almost everyone who expressed regret had upper-body tattoos, said Aslam and Owen.

Of 213 patients who regretted their tattoos, only 122 (57%) said they would like the tattoos removed.

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