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Background: Although permanent tattoos are becoming increasingly commonplace, there is a paucity of epidemiological data on adverse tattoo reactions. Several European studies have indicated that tattoo reactions may be relatively common, although the extent of this phenomenon in the United States is largely unknown., Objectives: To provide insights into the prevalence and nature of adverse tattoo reactions., Patients/materials/methods: We administered a survey about adverse tattoo reactions to 300 randomly selected tattooed people in Central Park, New York City., Results: Of 300 participants, 31 (10.3%) reported experiencing an adverse tattoo reaction, 13 (4.3%) reported acute reactions, and 18 (6.0%) suffered from a chronic reaction involving a specific colour lasting for >4 months. Forty-four per cent of colour-specific reactions were to red ink, which was only slightly higher than the frequency of red ink in the sampled population (36%). Twenty-five per cent of chronic reactions were to black ink, which was less than expected based on the number of respondents with black tattoos (90.3%). Study participants with chronic, colour-specific reactions had more tattoo colours than those without reactions., Conclusions: This study shows that tattoo reactions are relatively common, and that further investigation into the underlying causes is merited., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)