Having a tattoo can often lead to minor inflammation. However, depending on the circumstances, there may also be a risk of infection and other types of reaction.

According to a 2017 survey, 40% of people aged 18–69 years old in the United States have at least one tattoo. Furthermore, 1 in 4 of those with tattoos have several, while another 19% were thinking of getting a tattoo.

A 2016 study that looked at the risk of infection with tattoos found that 0.5–6% of adults who had a tattoo experienced infectious complications.

If a tattoo causes severe symptoms or pain that lasts for more than a few days, it can be a sign that there is an infection that needs medical attention.

Find out with this article about infections and tattoo reactions, prevention tips, and what to do if one or the other happens.

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In most cases, tattoos heal with basic care and hygiene.

When a person has a tattoo from a licensed, reputable tattoo artist in a salon setting, they may experience some pain, redness, and swelling. As the tattoo heals, itching may occur.

With basic care and good hygiene, most new tattoos heal within a few weeks, but some people may develop an infection that requires medical attention.

Symptoms of a tattoo infection include:

  • a rash, redness, or bumps in the tattoo area
  • a fever
  • worsening swelling
  • purulent drainage
  • increasing pain
  • shaking, chills, and sweats

Injecting ink introduces substances to the body that it does not usually encounter. Whether these are the ink components or bacteria, viruses, or other pathogens, there is a risk of an infection or reaction.

Bacteria and viruses

Contaminated equipment and ink can introduce bacteria to a wound site.

Various species of bacteria can cause infection after a tattoo, including:

  • Staphylococcus
  • Streptococcus

Some of these pathogens respond to antibiotics, but some do not. If a person develops an infection and does not seek medical help, it can lead to complications, such as deeper infections, and in rare cases, sepsis, which can be life threatening.

Anyone who has signs of an infection, including a fever and chills, should see a doctor.

Conditions that can result from a bacterial or viral infection, include:

Contaminated ink

In some cases, using contaminated ink or ink that is diluted with unsterilized water can lead to an infection.

One outbreak, which surfaced in January 2012, involved the bacteria Mycobacterium chelonae, a cause of skin and soft tissue infections. It affected 19 people in various U.S. states.

Symptoms included a persistent rash with redness, swelling, and papules in the tattoo area.

In this case, various artists had used a prediluted ink that had contamination in it before they purchased it.

Other reactions

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A person may experience a skin reaction to a tattoo.

Infection is relatively uncommon after a tattoo, but various other reactions can occur. These reactions include:

  • New or worsening symptoms of an existing skin condition, such as psoriasis.
  • Skin reactions, such as allergic contact dermatitis and photoallergic dermatitis.
  • An inflamed, red rash and scaly, flaking skin, depending on the reaction.

Learn more about psoriasis and tattoos.

Effect of ink

Tattoo ink consists of metals and other chemical substances, and these are what provide the color. For example, red tattoo ink may contain mercury sulfide, while blue ink contains cobalt aluminate.

Reactions to tattoo ink can vary, depending on the pigment it contains.

Potential reactions may lead to:

  • granuloma, or raised red bumps around the tattoo
  • lichenoid reactions, or itchy skin patches as in lichen planus
  • pseudolymphomatous reactions, involving purple or red nodules and plaques

Is there a link with skin cancer?

Authors of a 2014 study note that there have been cases of an overlap between squamous cell carcinoma and reactions at the site of a tattoo, raising concerns about skin cancer.

A review from 2018 concludes that there is not enough evidence to prove a link between tattoos and skin cancers. However, the authors recommend reporting any cases of skin cancer around tattoos to national skin cancer registries.

Also, some of the skin changes that may occur can be similar to those of skin cancer, making diagnosis more difficult should cancer arise.

The Food and Drug Administration (FDA) note that they have "not approved any pigments for injection into the skin for cosmetic purposes."

Tattooing can lead to an infection from the introduction of bacteria, viruses, or other unwanted substances into the body through broken skin.

Factors that can increase this risk when a person has a tattoo include:

  • using contaminated ink
  • using a do-it-yourself tattoo kit
  • unhygienic practices in unlicensed tattoo parlors
  • inappropriate wound care after the procedure
  • a weakened immune system before the procedure

Choosing a tattoo parlor that is fully licensed, with a trained and experienced tattoo artist, can reduce the risk. However, this will not account for all possible triggers.

An individual may still have a higher risk due to a preexisting condition, such as eczema, or ink where the manufacturing process caused contamination.

What happens to tattoo ink when it enters your skin? Learn all about it with this article.

Treatments that may help with inflammation and discomfort after a tattoo include:

Over the counter medications: Tylenol and nonsteroidal anti-inflammatory drugs (NSAIDs), for example, can help with pain and inflammation.

Antihistamine medications: Benadryl, for instance, can reduce symptoms of a minor allergic reaction, such as small, red bumps or a faint rash around the tattoo site.

Topical creams: A hypoallergenic, fragrance free cream can stop the skin from drying out.

Other aftercare tips include:

  • keeping the site clean by gently washing with soap and water
  • covering the tattoo site with a fresh, sterile gauze or bandage
  • wearing gloves while sleeping to avoid scratching a new tattoo

These measures can help reduce the risk of an infection occurring.

When to see a doctor

If there are more severe or persistent signs of infection, the person should see a doctor.

A doctor may take one or more of the following actions:

  • take a skin sample, or biopsy, to test for bacteria or viruses
  • prescribe oral or topical antibiotics
  • recommend hospitalization in severe cases

The FDA note that some people need to use antibiotics for several months. They add that if a person has an allergic reaction, symptoms may not go away because the tattoo ink is permanent.

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Finding a reputable tattoo artist may help minimize the risk of infection.

Anyone who is considering having a tattoo must choose a licensed, reputable, tattoo artist and salon.

People who should ask their doctor before going ahead include those with a weakened immune system or an existing blood or skin condition.

Questions to ask the tattooist before making the final decision to have a tattoo include:

  • How long has the tattoo artist been practicing?
  • How long have they been in business in the area?
  • What is their reputation, and are there any online reviews?
  • How clean is the overall facility, including the lobby?
  • How likely is the ink to cause a skin reaction?
  • Does the technician always use new needles, sterilized equipment, and single ink containers?
  • Will they use a sterile swab, rinse, or antiseptic wash to clean the area before starting the tattoo?
  • Will they wear sterile gloves throughout the procedure?

Anyone who does not feel comfortable with a salon, the equipment, or the artist, should choose another location.

Any activity that compromises the skin barrier or introduces foreign materials into the body increases the risk of an infection or other reaction. Many people experience a slight inflammation, but if symptoms persist, a person should see their doctor.

Antibiotic treatment can usually resolve a tattoo related infection. Without treatment, complications of a skin infection, such as a deeper infection, and, rarely, sepsis may occur in some people. When this happens, this can be life threatening.

Before deciding on a tattoo, people should learn as much as they can about the possible short term effects and how to prevent a problem.

They may also wish to consider the possibility of long term effects, although, as the FDA point out, the details of these are still unclear.

Q:

I have diabetes, but I would like to have a tattoo. Will it be safe? Should I make it a small tattoo?

A:

Having diabetes means that you must consider the risks carefully, particularly the risk of an infection. This is especially important if your diabetes is difficult to manage.

Before getting a tattoo, small or large, it is best to discuss the risks further with your doctor. Depending on the status of your diabetes, and other medical conditions, a doctor may be better able to assess your risk and whether it would be relatively safe to proceed.

After discussing with your doctor, you may want to consider getting a small tattoo at first and avoiding the tattoo on the lower legs.

Owen Kramer, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.