Do Psoriasis and Tattoos Mix?
Tattoos are a form of self-expression and have been around for centuries. On any given day, you’re apt to see someone with a visible tattoo while walking down the street.
With the ever-growing popularity of tattoos, you may be wondering about the safety of tattoos if you have psoriasis.
Below, we’ve outlined some safety considerations for you about psoriasis and tattoos.
Koebner Phenomenon
According to the Journal of Medicine and Life, the Koebner phenomenon is, “the development of several inflammatory skin lesions (psoriasis, lichen planus, vitiligo, etc.) in uninvolved skin following various traumatic insults."
For someone with psoriasis, this may mean that psoriatic lesions may develop following trauma to the skin.
It is estimated that 25% of people with psoriasis may suffer from lesions caused by the Koebner phenomenon following a trauma to the skin — and this can include tattooing.
The Journal of Medicine and Life did a case study on a real-life subject regarding the Koebner phenomenon. The subject was a 27-year-old male with psoriasis of the scalp, trunk, and arms. The lesions occurred on the trunk and arms two weeks post-tattoo when he was 18; he was diagnosed with scalp psoriasis when he was 14.
For four years before the tattooing, the subject had psoriasis that was limited to his scalp. After the tattoo, the psoriasis can spread to other areas of the body and was difficult to manage from that point on.
With the Koebner phenomenon, lesions appear in 10 to 20 days, although they can appear in three days to two years post-trauma. Other traumas may include burns, physical trauma, insect bites, allergic reactions, medications, acupuncture, surgical incisions and radiation exposure.
Although there is little studied about tattoos causing psoriasis, it has often been coined as “tattoo-induced psoriasis."
Psoriasis and Tattoos – Making Your Statement
Three in ten Americans have at least one tattoo, this according to a recent Harris Poll. Tattoos tend to be very acceptable these days, and they are particularly important for many with psoriasis.
Tattoos are a great way to express yourself. Unfortunately, tattoos cannot cover plagues and patchy skin spots. You also cannot place tattoos in areas of the body more to psoriasis breakouts, such as the scalp, elbows, and knees.
While you cannot cover embarrassing skin spots on your body, body art is a beautiful way to make your statement. It may also give you more confidence about showing your psoriasis-affected skin.
What Are the Risks?
If you are thinking about getting a tattoo, there some risks you should know about.
The most important thing to consider is that tattoos break into your skin, cause bleeding and bring with them a variety of risks, including:
- Infections
- Cross-contamination if needles are not properly sterilized
- Allergy to the dyes used
Your risk of infection is increased if you take immunosuppressants to treat psoriasis. These medications weaken the immune and make it harder for it to fight off bacteria.
It is also possible to have an infection even if you don’t take immunosuppressants. In fact, one study reported in the December 2011 Journal of the American Academy of Dermatology finds that people with psoriasis are twice as likely to be likely to be hospitalized for infections.
There are specific rules for sanitizing tools and needles set by Occupational Safety and Health Administration (OSHA), but there are no guarantee tattoo parlors will follow them. Not following OSHA guidelines can put a person at risk for developing a serious illness – for example, HIV, tuberculous, or hepatitis.
A review of studies in the March 2016 issue of Dermatology and Therapy found the red ink used in some tattoos can cause allergic skin reactions. These studies reviewed were general public studies, and not necessarily related to people with psoriasis.
Considerations
It is important to know your triggers. Skin trauma can result from tattoo needling, and it is possible these flares can be serious and last for more extended periods than you are used to.
It is also possible psoriasis plagues can occur in the newly tattooed areas, even those you did not have previously have plaques in those spots.
You shouldn’t get a tattoo if you are in the middle of a flare. This can aggravate your skin further, worsen the flare, and increase your chances of an infection or allergic reaction.
Some states may have laws preventing tattoo parlors from giving tattoos to people with skin lesions, sunburns, skin diseases and/or other skin problems. You may want to look into whether your state’s laws prohibit you from getting a tattoo.
You should also check with your doctor if any medications you take will affect your ability to get a tattoo. For example, topical steroid skin creams cause the skin to thin, possibly leading to skin breaks and bleeding.
Dermatologists may be a better position to answer questions about getting your skin tattooed. If you have a dermatologist, ask that person about safety considerations and potential risks.
You may want to start with a small tattoo so you can see how your skin reacts to tattooing. After that, you can decide if you want to get more tattoos.
Also, take into consideration that if you have skin patches and plaques, tattoos cannot be applied correctly. These skin areas are at higher risk for infection or allergic reaction.
Safe Tattoo Practice With Psoriasis
Consider the fact that psoriasis is an autoimmune disease. This means that the plaques on your skin are caused because your body perceives itself to be foreign and is attacking itself.
Any time you introduce something that is foreign to your body, you risk infection; if your body is in a current “attack" phase, it may be unable to fight the infection.
Knowing that Koebner phenomenon can happen to one in four people with psoriasis, you also must assess whether you want to take the risk of worsening your psoriasis. If the risk is worth it to you, there are steps you should consider when selecting a tattoo parlor.
Following these guidelines will minimize your risk of infection, although they will not reduce your risk of the Koebner phenomenon:
- Call the tattoo parlors before making any appointments. Better yet, visit the tattoo parlors. Ask about the cleanliness of their tattoo parlor, their cleaning procedures of needles (for example, do they sterilize needles or have single-use needles) and any other questions you may have. Visiting the parlor is especially helpful because you can visually inspect for cleanliness.
- Ensure that the tattoo artist is registered or has some certification. Registration/licensing/certification varies state to state and country to country, but you would want to ensure that the tattoo parlor is up-to-date on their licensees.
- Ensure that the dyes used for tattooing are meant for tattooing. Untested dyes, even if other people have not had issues, may cause a reaction in someone with psoriasis.
- Even if you want a tattoo, it is imperative that you discuss it with your healthcare provider. They will discuss the pros and cons based on your particular history, especially if you have other health conditions.
Not All Tattoo Shops Are the Same
Once you have decided you would like to get a tattoo, you should do your research before going in for a tattoo. After all, not all tattoo shops are the same and not all follow guidelines established by OSHA and state law.
If you decide you want to go a specific tattoo parlor, make sure you verify the following about the tattoo parlor:
- If it is reputable
- The shop and artists are properly licensed
- The shop is clean
- Artists wear gloves during tattooing
- Artists understand proper sterilization of all tools
- Ink cups are only used for the one person getting the tattoo and thrown out afterward
- Fresh needles are used each time
You should verify this information for every parlor you are considering until you find one that meets your expectations and gives you little or no stress about getting a tattoo.
Remember, getting a tattoo is a deeply personal decision. It is a statement of expression, but it is also an expression that you will wear for the rest of your life. Weigh the pros and cons before making your appointment.
After Getting a Tattoo
Chances are you will receive an instruction sheet after getting your tattoo that will explain how to care for your tattoo until it is healed. You should ask all your questions before leaving the shop and call them if you think of anything later.
Your tattoo site will be itchy and swollen, which is generally normal. Tattoos typically take at least two weeks to heal.
The tattoo will scab, and the scab will eventually fall off. It is important not to scratch the tattoo site, as this may slow down the healing and increase your risk for infection.
If you notice redness and excessive swelling, you should call your doctor right away, as these might be signs of an infection. Any new psoriasis plaques at or near the tattoo site should also be reported to your doctor immediately, as these may be related to the Koebner phenomenon.
The Bottom Line
There is not enough research to confirm getting a tattooing worsens your psoriasis. Moreover, there has been little evidence that adverse harm occurs when people with psoriasis get tattoos.
Of course, it is a good idea to talk to your doctor about any increased risks that apply to you, including your heightened risk for infection and any medications that would cause you to get an adverse reaction.
Do your research before visiting a tattoo parlor and getting tattooed. Avoid getting tattoos in areas with skin lesions and broken skin.
If you are looking for some tattoo inspiration and ideas, visit the National Psoriasis Foundation’s tattoo gallery.