Getting a Tattoo with Chronic Skin Conditions? A Rundown on the Pros and Cons, Risks and Aftercare

Tattoos are a popular form of self-expression. In the UK itself, around one in five of the UK population is tattooed. A third of the people with this body art claim that it has helped with their body image and that the tattoo made them feel sexy. Another third, claim that tattoos made them look or feel rebellious and that their self-esteem increased. Although there is no one reason why people would want to get permanently etched on their skin, it is best to be cautious when doing so.

Tattoo and Psoriasis

If you have psoriasis and really want a tattoo, know that many people with the same skin condition also want to camouflage their psoriatic lesions. They find that tattoos help them with their body image and having one has improved their level of psoriasis acceptance. 

According to Pubmed, psoriasis is not a strict contraindication for tattooing. However, there are certain controversies about whether it is safe to get a tattoo in the active stage of the disease, especially while undergoing immunosuppressive treatment. Although, note that there are only a few cases of serious tattoo-related infectious complications caused by immunosuppression.

If you have psoriasis, is it safe to get a tattoo?

Psoriasis is an autoimmune problem that involves hyperproliferation of the keratinocytes in the epidermis (top layer of skin). According to NHS UK, it occurs when there’s a problem in the immune system causing skin cells to be replaced more quickly than usual. It is a chronic skin condition, which means, it can flare up unexpectedly and there’s no cure.

Since psoriasis may have a prolonged inflammatory state, some tattoo parlors may not agree to tattoo a person with such conditions. Some tattoo artists will not apply a tattoo even if the psoriasis is not currently active. In fact, in some areas in the US, they have a law that specifically mentions psoriasis. It prohibits artists from tattooing people with active eczema or psoriasis.

For example, tattoo artists in Oregon, Wisconsin, and Louisiana aren’t permitted to work on any area of the skin where there are lesions. Louisiana even has a clause that specifically mentions psoriasis. South Carolina also prohibits tattooing on skin with any type of irregularity, such as a rash, sunburn, lesion, or pimple. You may read more about it here.

Fig. 1. Some places have laws against getting a tattoo if you have psoriasis

Things To Know Before Getting A Tattoo If You Have Psoriasis

Location of tattoo

A person with psoriasis may get tattoos, but because psoriasis plaques can occur almost anywhere on the body, it is recommended to have it where your skin usually doesn’t get flare-ups. It isn’t possible to get a tattoo in areas where there are scale-like patches or psoriatic plaques. If your skin changes often, getting a tattoo may make it seem unpredictable and may also be disappointing in some cases because the tattoo may be hard to see.

Choosing a Tattoo Parlor

So you have already decided which part of your body you’ll be getting inked on. The next step is to pick a safe tattoo parlor. When you visit one, check:

• if the tattoo parlor looks clean and has proper sanitization processes
• if the tattoo studio is registered
• the appearance of the walls and floors
• if the tattoo studio looks well-lit and well-maintained
• if needles and stains are scattered all over the place (this is a red flag)

Aside from these, here’s a list of the things that you should look for in a studio, as suggested by a campus health and wellness resource:

• It should have separate areas for body piercing and tattooing, in case it’s not just a tattoo shop
• Needles should only be used once and should be opened (from individual packages) in front of you before the procedure
• Make sure that the staff wear gloves (new ones) during each procedure
• Tattoo ink used should be placed in a single-use cup and then disposed of. Tattoo ink should never be taken directly from the main source bottle or returned to that bottle!

To prevent infection, choose a reputable tattoo studio that is clean and has proper sanitization processes. For example, every tattoo parlor should have a machine called an autoclave that sterilizes instruments at ultra-high heat. If there is no autoclave, it’s best not to agree to the procedure.

Fig. 2. Choose a hygienic tattoo parlor

Tattoo artist

Aside from picking a safe tattoo parlor, it is also important to choose a licensed tattoo artist. To help prevent infection, be sure your tattoo artist is licensed and reputable.

Ask questions like how long has the person been tattooing? Is he knowledgeable? Then, discuss your ideas with your chosen artist.

One tattoo artist shared that if clients have a good understanding of their experiences with psoriasis as well as the condition of their skin at the time of the visit, it helps in making the best decisions for safely executing the artwork and tattoo placement. She has so far been successful with her clients who have psoriasis.

Risks and Complications

Know your risks

Getting tattooed in itself already has risks like an allergic reaction to tattoo dyes, bacterial infections, and bloodborne diseases from cross-contaminated tattoo needles and equipment (HIV, hepatitis B or C, tuberculosis, and tetanus included).

Tattoos can cause bleeding. This by itself makes anyone who gets a tattoo vulnerable to various tattoo-related complications.

Koebner phenomenon may occur

Psoriasis flares can be triggered by any skin injury or trauma like cuts, scrapes, burns, sunburns, insect bites, and puncture wounds. This can cause plaques to appear in new places where they normally weren’t. This is called the Koebner phenomenon. Those with psoriasis have a higher risk of experiencing this reaction, which can lead to tattoo-induced psoriasis. This is a real risk for psoriatic patients who are getting a tattoo.

Tattooing can exacerbate these conditions. Since tattoos cause skin trauma, for some, the Koebner phenomenon occurs after getting tattooed. It’s estimated that 11% to 75% of psoriatic patients will experience the Koebner phenomenon after a skin trauma such as getting tattooed.

It’s also important to be aware that when the Koebner phenomenon occurs in tattooed skin, it might continue to reoccur in the same location, which might permanently disturb the tattoo site. For some, luckily their skin was fine after getting a tattoo and they say that after the psoriatic lesions heal, the tattoo is unaffected.

Tattoo complications in treated and non-treated psoriatic patients

Two separate studies showed that the rate of tattoo complications in psoriasis patients was low. It was also noted that although the risk of complications was highest amongst psoriatic patients requiring treatment at the time of tattooing, all complications observed were only benign.

In the second study, one by Patrycja Rogowska and colleagues at the Medical University (MU) of Gdańsk in Poland, it was found that almost two-thirds of the respondents were in active treatment while being tattooed. Some were receiving topical psoriasis treatment while others were receiving systemic treatment and phototherapy.

This study also reported that “active systemic therapy for psoriasis can leave patients who are planning to get inked vulnerable to tattoo-related complications.” In addition, it reported that oral retinoids can thin the skin and cause excessive dryness and that this can also impair the wound healing process and increase the chance of infection.

Safety Measures

If you’re prone to skin allergies, you may want to do a patch test before the procedure to see how your skin might react to the tattoo ink. Aside from this, have a dermatological consultation before getting inked, especially for a psoriatic patient. In a study published this year about how much patients with psoriasis know about tattooing and its potential complications, dermatological counseling was recommended for patients with psoriasis who are considering tattooing.

Speak with your dermatologist before getting a tattoo to fully weigh the pros and cons based on your medical history and personal risk factors. This is to determine the best time to have the procedure done and to assess the safest location for the tattoo.

In the above-mentioned study, the researchers concluded that “a standardized questionnaire, inclusive query about the client’s medical history and medications, could be implemented by tattooists for the benefit of the whole tattoo society.”

Moreover, here are a few of Rochford UK’s Advice and Safe Practice for Permanent Tattooing, for those who are in the business of tattooing:

Tattoo Practice Standards

• Basics of work area and sink to ensure safe treatment:
  • All smooth, impervious surfaces should be cleaned with detergent and disinfected by wiping with a suitable disinfectant between clients to prevent infection (cross-contamination)
  • A separate deep sink with hot and cold water should be provided exclusively for washing equipment; it should be located in a separate ‘dirty’ area, away from the clean operating area; etc
• Needles must only be used once and then disposed of after each client
• To clean and prepare the client’s skin before treatment, thoroughly wash the area with soap and water, followed by drying with a clean disposable towel
• A fresh pair of disposable examination-style gloves must be worn during each tattooing procedure and must be disposed of between clients to avoid cross-contamination. Never wash and reuse disposable gloves
• To avoid tattoo equipment being contaminated, good cleaning, disinfection, and sterilization practices must be done. Parts of the equipment that come in direct contact with the client’s skin (needles, bars, and needle tips) must be one-use only. Any other parts that become contaminated but have to be re-used must be thoroughly cleaned and disinfected.

Prohibitions

In addition to this, in some countries a published law prohibits tattooing:

• On a person with sunburn or other skin diseases or disorders such as open skin lesions, rashes, wounds, puncture marks in areas of treatment, etc

What Is The Recommended Tattoo Aftercare Especially For People With Chronic Skin Conditions?

Fig. 3. Tattoo aftercare can help manage chronic skin problems

Doctor Clare Morrison, GP & Medical Advisor at Medexpress UK shares about tattoo aftercare:

• always wash your hands before tending to your unhealed tattoo. Getting a tattoo done is still technically a medical procedure. And an open wound requires careful aftercare to avoid scarring and infection.
• For the first 2-3 days, keep the tattoo covered with clingfilm (The tattoo parlor will clean it and wrap it in clingfilm after the tattoo procedure). Change it at least three times a day and gently clean the tattoo with water before re-applying.
• Clean the tattoo before each application of moisturizer for the first 2-3 days. Apply a tattoo care moisturizer 2-3 times a day.
• Make sure to maintain a high level of personal hygiene as the tattoo heals, similar to how you would care for an open wound.
• Resist the urge to pick light scabbing as this can cause scarring and color gaps

Follow aftercare instructions precisely. Contact your dermatologist right away if you experience new or worsening lesions or any of these signs:

• For tattoos on your arms and legs, if a red linear band or streak develops and extends from the area.
• Worsening pain around the tattoo within the next five to seven days
• Discharge coming from the area.
• Having a fever (a sign of infection).

Skincare For Your Chronic Skin Condition

As important as your tattoo aftercare is how you manage your skin’s chronic conditions like psoriasis and eczema. While many over-the-counter medications are already available for calming skin conditions, they may not all be very effective. On the other hand, Medovie has skincare products designed for effectively managing eczema and psoriasis symptoms. Our Body solutions as well as Scalp solutions have been proven to calm sensitive skin. 

We invite you to set a meeting with our Medovie skincare experts to get the appropriate solution for your condition.