Can You Get a Tattoo with Psoriasis?

Skin conditions can make tattoos complicated. Here are the important facts and risks to consider when deciding what’s best for you.

Most people don’t consider their health conditions prior to getting a tattoo, but if you have psoriasis (PsO), you may have more to consider than most. If you have PsO, you may still be able to get a tattoo, but it’s important to understand the risks that may come with it.

About 10–30% of people in Western countries have tattoos, and about 10% of people with tattoos experience a complication.

Safety considerations for getting tattoos with PsO include:

• location
• infection
• allergic reaction
• scarring
• inflammation
• the Koebner phenomenon

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Location

First and foremost, you can’t tattoo over an active plaque. The tricky part is that PsO plaques can occur in new places and anywhere on the body. So, it might be difficult to find the ideal spot for your forever artwork.

If you have had PsO for a long time, this may be easier for you to predict, especially if your PsO tends to be in limited areas, like your elbows and knees.

Infection

Since tattoo needles repeatedly puncture the skin, any new tattoo runs the risk of infection. This is called cellulitis, or an infection of the skin.

When it comes to tattoo infection and PsO, you might have a higher chance of infection if you’re currently receiving immunosuppressive therapy, such as methotrexate.

Signs of an infected tattoo include:

• pain
• a persistent and bumpy rash
• open wounds or blisters that do not heal
• excessive amounts of bleeding and drainage
• a foul odor

You can also contract a serious infection from inadequately or improperly sanitized tools and equipment used during the tattooing process. These serious infections may include:

• HIV
• hepatitis B
• hepatitis C
• tetanus
• nontuberculous mycobacterial skin infections

Rarely, tattoo inks have been recalled for microorganism contamination, which can also cause an infection.

Infection prevention is done in two ways:

1. Proper sterilization and technique by the tattoo artist and tattoo parlor
2. Proper hygiene and aftercare by you after leaving the tattoo parlor

Be sure to discuss any plans to get a tattoo with your doctor, too.

Koebner phenomenon

The Koebner phenomenon is when skin lesions appear in places where you don’t usually experience them. Any skin trauma, such as a cut, sunburn, or bug bite, can trigger this. People with PsO are 25% more likely to experience this phenomenon.

Since tattoos cause small traumas through recurring needle punctures, this may happen with the tattoo process. It typically occurs 10–20 days after the injury or tattoo — but it can take as little as 3 days or as long as 2 years to appear.

This is something worth considering prior to getting a tattoo.

Allergic reaction

Some tattoo dyes and inks can cause an allergic reaction. Although this is not specific to people living with PsO, this is something to be aware of before making the decision to get a tattoo.

Scarring

Certain areas are more prone to scarring than others. This includes the:

• chest
• shoulders
• upper arms

Since tattoos are permanent, the ink is left in the middle layer of your skin. A reputable tattoo artist will know how deep to go, but poor technique involving tattooing into deeper dermal layers can cause scarring.

Instead of a smooth finish, these areas may appear sunken or raised. The colors may also be distorted from this scarring.

More commonly, scarring is caused by poor aftercare. Be sure to follow the instructions provided by your tattoo artist for care to prevent this complication.

Care for a tattoo

In the days and weeks after getting a tattoo:

• Follow your tattoo artist’s instructions about when to remove the dressing.
• Once the dressing is removed, wash with warm water and fragrance-free soap twice a day.
• If your tattoo artist recommends an ointment (like Aquaphor), let the skin dry completely prior to applying.
• Do not pick scabs or scratch at the tattoo.
• You may notice some bleeding of ink when you wash the area. This is normal.
• Get medical attention if you notice any signs of infection or an allergic reaction:
  • redness
  • pain
  • swelling
  • excessive drainage

Tips for caring for a tattoo long-term include:

• Use sun protection to avoid fading.
• When possible, avoid rapid weight loss or weight gain, which can stretch the skin.
• Drink plenty of water to keep your skin hydrated.

Risk of refusal

You may be completely prepared to get your new tattoo, but your tattoo artist can refuse to perform the service.

Some parts of the United States have laws restricting tattoo artists from working on people with skin conditions, like PsO.

For example, tattoo artists in Oregon, Wisconsin, and Louisiana aren’t allowed to work on any area of the skin where there are skin lesions. Louisiana even has a clause that specifically mentions PsO. South Carolina has a specific clause prohibiting tattooing on the skin with any irregularity, such as a rash, sunburn, lesion, or pimple.

Important questions

Ask your doctor

If you have PsO, be sure to discuss your plans for tattoos with your doctor first. They may have instructions or advice that is specific to your condition.

Ask your tattoo artist

• What are your sanitation techniques?
• Are tools that can’t be sanitized discarded after each client?
• What types of inks do you use, and have there been any active recalls on your products?
• Do you have experience giving people with PsO tattoos?
• Do you wear gloves throughout the whole procedure?

Ask yourself

• Am I comfortable with getting a tattoo here?
• Does the tattoo artist and parlor have a good reputation?
• Do I understand the risks?

Other things to consider

Even when making the best choice for the location of your new tattoo, there’s no guarantee that a new PsO lesion won’t appear there.

PsO and some treatments can raise your chances of infection.

Even though temporary tattoos, like henna, are less invasive than traditional tattoos, there is still a risk of skin trauma and infection.

The takeaway

For more personal accounts, the National Psoriasis Foundation has a page that shares stories of women with PsO who have tattoos. It includes details on how tattoos affected their condition and the decisions they made along the way.

Getting a tattoo is a big decision — and even more so if you have PsO. Knowing the risks can help you make the best decision for you.