According to survey results from The Harris Poll, an estimated 20 percent of adults in the United States have at least one tattoo. While tattoos may be common culturally, they represent a more significant choice when a person has psoriasis.
Not only does the presence of psoriasis on the skin make deciding where to potentially place a tattoo difficult, those with psoriasis are at an increased risk of something called the Koebner phenomenon. This is also known as tattoo-induced psoriasis.
While doctors are still without a definitive answer as to who is at risk for the Koebner phenomenon or the safety of getting a tattoo with psoriasis, there are some factors that a person should consider before going under the needle.
How might getting a tattoo affect someone with psoriasis?
Some states have laws that prohibit tattoo artists from working on people with active psoriasis.
Psoriasis causes a person to develop scale-like patches or plaques on the skin. The location of these plaques can vary based on the type of psoriasis a person has.
For example, when a person has nail psoriasis, the condition is usually limited to their fingernails and toenails, whereas plaque psoriasis - the most common form of the condition - causes a person to experience these skin lesions virtually anywhere on the body.
When a person considers where to put a tattoo and they have psoriasis, they can rarely be certain they won't experience a psoriasis outbreak when they get the tattoo. If an outbreak occurs, the tattoo cannot be effectively applied due to the buildup of skin cells.
A person who gets a tattoo where they commonly experience psoriasis may not be able to see the tattoo well due to the existence of plaques in the tattoo's location.
Tattoos themselves also carry risks for infections as well as allergic reactions.
Because a person with psoriasis has an inflammatory skin process, some tattoo shops may not place a tattoo on a person who has psoriasis. This sometimes extends to if a person's psoriasis is active or not.
Some states have laws that prohibit tattoo artists from doing a tattoo on a person that has active eczema or psoriasis. The person may have to wait until their psoriasis is dormant before getting the tattoo. For some individuals, this may rarely or never occur.
What is the Koebner phenomenon?
The Koebner phenomenon is the development of skin lesions after an injury to previously healthy skin. This can be as simple as a scratch or a response to tattooing.
Patients with psoriasis are at particular risk for the Koebner phenomenon.
While a person may choose a location for their tattoo that has never had an outbreak, they are at risk of developing new psoriasis plaques on the tattoo.
For example, a person with psoriasis may choose a location for a tattoo on their body where they have never experienced a psoriasis outbreak or had problems. After the tattoo is applied, a person may experience a psoriasis-like outbreak on the tattoo.
This reaction can sometimes take anywhere from 10 days to 2 years to appear. According to a paper published in CMAJ, an estimated 25 percent of people with psoriasis will experience the Koebner phenomenon after traumatic injury, such as a tattoo.
The Koebner phenomenon causes what is known as an isomorphic response. This means that the outbreak and symptoms are usually limited to the area of skin damage. Similar to psoriasis in general, the skin condition is not contagious.
The difficulty with the Koebner phenomenon is that doctors do not really know what causes the condition to occur. They do know that people with psoriasis are the most affected. However, they cannot predict when a person with psoriasis will or won't experience the Koebner phenomenon after getting a tattoo.
For this reason, a person with psoriasis must understand that they are at risk for experiencing lesions on the tattooed area, even if they haven't ever had psoriasis plaques on that particular area.
The Koebner phenomenon is temporary, but any psoriasis outbreak that it may cause can be treated in the same way as other psoriasis outbreaks. Treatment options for affected skin include oral drugs, light therapy, and topical treatments applied directly to the skin.
Considerations and safety risks
Skin trauma is one of the main triggers associated with psoriasis, along with stress and excess sun exposure.
People should be sure to ask which inks their tattoo artist is using, as some inks can have a bacterial contamination.
It is important that a person with psoriasis knows that they are at increased risk for having their psoriasis flare up before and after they get a tattoo.
In addition to knowing that a flare-up can occur, it is also important that a person with psoriasis considers the same risks any person does when getting a tattoo.
These include the potential for:
- Allergic reaction: The dyes used to produce tattoo inks can sometimes cause allergic reactions. For some people, these reactions are so severe that they have to start the tattoo removal process.
- Cross-contamination: While there are rules for sanitizing tools and needles, there is no guarantee that everyone will follow them. It is possible that a person can contract a serious illness due to being tattooed with a contaminated needle.
- Infection: Tattoo needles break the skin to apply the dye. Therefore, they can introduce bacteria and other unwanted germs into the skin, potentially causing serious infections.
- Ink contamination: Before getting your tattoo applied, be sure to ask the artist which brand and colors of ink they will be using. Be sure to research if there are any active recalls, as they have been known to have bacterial contamination.
If a person with psoriasis does get a tattoo, they should be familiar with the symptoms that signal the need to see a doctor. Examples of these symptoms include extreme redness and burning.
Skin symptoms from a tattoo should lessen with time, not worsen. If a person's symptoms become worse, this is cause for concern.
Questions to ask before a tattoo
Before getting a tattoo, it is important for people to ask the tattoo shop and artist about their sanitation techniques and how they keep their equipment clean.
For example, a tattoo shop should have a machine called an autoclave that can sterilize instruments at ultra-high heats. Staff should also always wear gloves during the procedure.
Tattoo inks should be placed in a single-use cup and thrown way after a tattoo. A person may wish to ask to observe how the tattoo artist prepares the instruments before getting a tattoo. While the shop does not have to agree to this step, it can provide peace of mind for some people.
A person should also ask and follow the tattoo shop's advice on how to prevent infection and promote healing.
In addition, a person with psoriasis may wish to ask their dermatologist about getting a tattoo, considering their overall health and psoriasis condition. As tattoos are so common, a person with psoriasis should not fear judgment from a dermatologist.
However, the doctor who knows their unique skin condition may be able to share concerns or advice to the person to make sure of their safety if they decide to proceed with getting the tattoo.