A Practical Guide About Tattooing in Patients with Chronic Skin Disorders and Other Medical Conditions

Abstract

With tattoos becoming increasingly mainstream, dermatologists are more and more often consulted by patients who are considering getting an ornamental, cosmetic, or even a medical tattoo, and who subsequently ask for advice. This includes not only patients with chronic skin diseases such as psoriasis or atopic dermatitis but also patients with other medical conditions. This review first explores the reasons why patients may want to get a tattoo and aims to offer some key information to dermatologists on what they should know about tattooing and the main risks associated with this procedure. Second, the risks and recommendations of tattooing in patients with specific skin diseases are described more in detail, and the relative and strict contraindications discussed, including the necessity to discontinue certain treatments that could influence the outcome of the procedure and the final result. Our aim was to provide dermatologists with the current knowledge they need to help their patients make adequate and informed choices on skin art, focusing specifically on considerations in patients with chronic skin conditions. Finally, other aspects regarding some general systemic conditions and concomitant diseases that the patient could present are also addressed. In particular, the risks of tattooing in patients with diabetes, coagulation disorders, heart conditions, immunosuppressive treatments, and pregnancy are discussed.

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References

  1. 1.

    Kluger N. Epidemiology of tattoos in industrialized countries. Curr Probl Dermatol. 2015;48:6–20.

    Article  PubMed  Google Scholar 

  2. 2.

    Shannon-Missal L. Tattoo takeover: three in ten Americans have tattoos, and most don’t stop at just one. Harris Poll 10 Feb 2016. http://www.theharrispoll.com/health-and-life/Tattoo_Takeover.html. Accessed 10 July 2017

  3. 3.

    Wohlrab S, Stahl J, Kappeler PM. Modifying the body: motivations for getting tattooed and pierced. Body Image. 2007;4:87–95.

    Article  PubMed  Google Scholar 

  4. 4.

    De Cuyper C. Permanent makeup: indications and complications. Clin Dermatol. 2008;26:30–4.

    Article  PubMed  Google Scholar 

  5. 5.

    Kluger N, Aldasouqi S. The motivations and benefits of medical alert tattoos in patients with diabetes. Endocr Pract. 2013;19:373–6.

    Article  PubMed  Google Scholar 

  6. 6.

    Kluger N, Aldasouqi S. A new purpose for tattoos: medical alert tattoos. Presse Med. 2013;42:134–7.

    Article  PubMed  Google Scholar 

  7. 7.

    Kluger N. Tattooing, piercing and inherited coagulation disorders. Haemophilia. 2013;19:e358–9.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Kluger N. Body piercing and tattooing among French patients with bleeding disorders. Presse Med. 2017;46:538–40.

    Article  PubMed  Google Scholar 

  9. 9.

    Kluger N. Tattooing and piercing: an underestimated issue for immunocompromised patients? Presse Med. 2013;42:791–4.

    Article  PubMed  Google Scholar 

  10. 10.

    Kluger N. Tattooing and immunodepression: caution is warranted also in organ transplant patients. Transpl Infect Dis. 2017. doi:10.1111/tid.12701.

    PubMed  Google Scholar 

  11. 11.

    Vassileva S, Hristakieva E. Medical applications of tattooing. Clin Dermatol. 2007;25:367–74.

    Article  PubMed  Google Scholar 

  12. 12.

    Seité S, Deshayes P, Dréno B, Misery L, Reygagne P, Saiag P, Stengel F, Roguedas-Contios A, Rougier A. Interest of corrective makeup in the management of patients in dermatology. Clin Cosmet Investig Dermatol. 2012;5:123–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Drost BH, van de Langenberg R, Manusama OR, Janssens AS, Sikorska K, Zuur CL, Klop WM, Lohuis PJ. Dermatography (Medical Tattooing) for scars and skin grafts in head and neck patients to improve appearance and quality of life. JAMA Facial Plast Surg. 2017;19:16–22.

    Article  PubMed  Google Scholar 

  14. 14.

    Laux P, Tralau T, Tentschert J, Blume A, Al Dahouk S, Bäumler W, Bernstein E, Bocca B, Alimonti A, Colebrook H, de Cuyper C, Dähne L, Hauri U, Howard PC, Janssen P, Katz L, Klitzman B, Kluger N, Krutak L, Platzek T, Scott-Lang V, Serup J, Teubner W, Schreiver I, Wilkniß E, Luch A. A medical-toxicological view of tattooing. Lancet. 2016;387:395–402.

    Article  PubMed  Google Scholar 

  15. 15.

    Wollina U. Severe adverse events related to tattooing: an retrospective analysis of 11 years. Indian J Dermatol. 2012;57:439–43.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Simunovic C, Shinohara MM. Complications of decorative tattoos: recognition and management. Am J Clin Dermatol. 2014;15:525–36.

    Article  PubMed  Google Scholar 

  17. 17.

    Kluger N. Cutaneous and systemic complications associated with tattooing. Presse Med. 2016;45:567–76.

    Article  PubMed  Google Scholar 

  18. 18.

    Jafari S, Buxton JA, Afshar K, Copes R, Baharlou S. Tattooing and risk of hepatitis B: a systematic review and meta-analysis. Can J Public Health. 2012;103:207–12.

    PubMed  Google Scholar 

  19. 19.

    Jafari S, Copes R, Baharlou S, Etminan M, Buxton J. Tattooing and the risk of transmission of hepatitis C: a systematic review and meta-analysis. Int J Infect Dis. 2010;14:e928–40.

    Article  PubMed  Google Scholar 

  20. 20.

    Wenzel SM, Rittmann I, Landthaler M, Bäumler W. Adverse reactions after tattooing: review of the literature and comparison to results of a survey. Dermatology. 2013;226:138–47.

    Article  PubMed  Google Scholar 

  21. 21.

    Wenzel SM, Wenzel J, Hafner C, Landthaler M, Baumler W. Permanent make-up colorants may cause severe skin reactions. Contact Dermatitis. 2010;63:223–7.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Serup J, Hutton Carlsen K. Patch test study of 90 patients with tattoo reactions: negative outcome of allergy patch test to baseline batteries and culprit inks suggests allergen(s) are generated in the skin through haptenization. Contact Dermatitis. 2014;71:255–63.

    Article  PubMed  Google Scholar 

  23. 23.

    De Cuyper C, Lodewick E, Schreiver I, Hesse B, Seim C, Castillo-Michel H, Laux P, Luch A. Are metals involved in tattoo-related hypersensitivity reactions? Case Report. Contact Dermatitis. 2017;30:683–90.

    Google Scholar 

  24. 24.

    Kluger N. Contraindications for tattooing. Curr Probl Dermatol. 2015;48:76–87.

    Article  PubMed  Google Scholar 

  25. 25.

    Kluger N. Can a mother get a tattoo during pregnancy or while breastfeeding? Eur J Obstet Gynecol Reprod Biol. 2012;16:234–5.

    Article  Google Scholar 

  26. 26.

    Kluger N, Comte C. Isotretinoin and tattooing: a cautionary tale. Int J Dermatol. 2017;56(10):e199–200. doi:10.1111/ijd.13687.

    Article  PubMed  Google Scholar 

  27. 27.

    Grabb WC, MacCollum M, Tan NG. Results from tattooing port-wine hemangiomas. A long-termfollow-up. Plast Reconstr Surg. 1977;59:667–9.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Kluger N, Bosonnet S. Keloid occurring in a tattoo. Ann Dermatol Venereol. 2017;144:455.

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Guillem P, Raynal H, Wendling A, Kluger N. P019 Hidradenitissuppurativa influences tattooing practices in women. Exp Dermatol. 2017;26:36–7.

    Article  Google Scholar 

  30. 30.

    Taaffe A, Wyatt EH. The red tattoo and lichen planus. Int J Dermatol. 1980;19:394–6.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Kluger N. Cutaneous complications related to tattoos: 31 cases from Finland. Dermatology. 2017;233:100–9.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Fields JP, Little WD Jr, Watson PE. Discoid lupus erythematosus in red tattoos. Arch Dermatol. 1968;98:667–9.

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Kluger N, Koljonen V. Tattoos, inks, and cancer. Lancet Oncol. 2012;13:e161–8.

    Article  PubMed  Google Scholar 

  34. 34.

    Kluger N, Thomas L. The dragon with atypical mole syndrome. Arch Dermatol. 2008;144:948–9.

    PubMed  Google Scholar 

  35. 35.

    Kluger N, Catala D, Thibaut I. Naevus and tattooing: a matter of concern. J Eur Acad Dermatol Venereol. 2008;22:767–8.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Kluger N. Tattooing and psoriasis: demographics, motivations and attitudes, complications, and impact on body image in a series of 90 Finnish patients. Acta Dermatovenerol Alp Pannonica Adriat. 2017;26:29–32.

    PubMed  Google Scholar 

  37. 37.

    Kluger N, Estève E, Fouéré S, Dupuis-Fourdan F, Jegou MH, Lévy-Rameau C. Tattooing and psoriasis: a case series and review of the literature. Int J Dermatol. 2017;56:822–7.

    Article  PubMed  Google Scholar 

  38. 38.

    Hutton Carlsen K, Serup J. Photosensitivity and photodynamic events in black, red and blue tattoos are common: a ‘Beach Study’. J Eur Acad Dermatol Venereol. 2014;28:231–7.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Kluger N. Sarcoidosis on tattoos: a review of the literature from 1939 to 2011. Sarcoidosis Vasc Diffuse Lung Dis. 2013;30:86–102.

    CAS  PubMed  Google Scholar 

  40. 40.

    Sepehri M, Hutton Carlsen K, Serup J. Papulo-nodular reactions in black tattoos as markers of sarcoidosis: study of 92 tattoo reactions from a hospital material. Dermatology. 2016;232:679–86.

    Article  PubMed  Google Scholar 

  41. 41.

    van der Velden EM, Drost BH, Ijsselmuiden OE, Baruchin AB. Dermatography: 10 years of applications as adjuvant treatment after nipple and areola reconstruction. Am J Cosmetic Surg. 2000;17:23–6.

    Article  Google Scholar 

  42. 42.

    van der Velden EM, Defrancq J, Ijsselmuiden OE, Baruchin AM, Hulsebosch HJ. Dermatography: a review of 15 years of clinical applications in surgery. Int J Cosm Surgery Aest Dermatol. 2001;3:151–9.

    Article  Google Scholar 

  43. 43.

    Farhadi J, Maksvytyte GK, Schaefer DJ, Pierer G, Scheufler O. Reconstruction of the nipple-areola complex: an update. J Plast Reconstr Aesthet Surg. 2006;59:40–53.

    Article  PubMed  Google Scholar 

  44. 44.

    Boulart L, Mimoun M, Noel W, Malca N, Chaouat M, Boccara D. Dealingwithtattoos in plastic surgery. Complications and medical use. Ann Chir Plast Esthet. 2017;62(2):e23–9.

    CAS  Article  PubMed  Google Scholar 

  45. 45.

    Spyropoulou GA, Fatah F. Decorative tattooing for scar camouflage: patient innovation. J Plast Reconstr Aesthet Surg. 2009;62(10):e353–5.

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Yoo JJ, Kim HS, Kim JH, Joo M, Kim KJ, Park S, Jang YC. Clinical features and treatment outcomes of skin cancer arising from burn scar: a single-institution experience. Tumori. 2014;100:26–30.

    PubMed  Google Scholar 

  47. 47.

    Goldstein N IV. Complications from tattoos. J Dermatol Surg Oncol. 1979;5:869–78.

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Arun B, Jamieson L, Mendonca C. An unusual presentation of lichen sclerosus et atrophicus in a tattoo. Clin Exp Dermatol. 2010;35:441.

    CAS  Article  PubMed  Google Scholar 

  49. 49.

    Kluger N, Trouche F. Vitiligo on a tattoo. Ann Dermatol Venereol. 2011;138:549–50.

    CAS  Article  PubMed  Google Scholar 

  50. 50.

    Ahluwalia R, Mills A, Cuthbertson D. An, “Avatar” infection: association cellulitis in a type 2 diabetes patient following decorative tattooing. Pract Diabetes. 2011;28:292.

    Article  Google Scholar 

  51. 51.

    Kluger N, Godenèche J, Vermeulen C. Granuloma annulare within the red dye of a tattoo. J Dermatol. 2012;39:191–3.

    Article  PubMed  Google Scholar 

  52. 52.

    Babin-Muise D, Miller R, Murray S, Walsh N. Necrobiosis lipoidica diabeticorum in a tattoo site. J Cutan Med Surg. 2012;16:286–7.

    Article  PubMed  Google Scholar 

  53. 53.

    Satchithananda DK, Walsh J, Schofield PM. Bacterial endocarditis following repeated tattooing. Heart. 2001;85:11–2.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Tse D, Khan S, Clarke S. Bacterial endocarditis complicating body art. Int J Cardiol. 2009;133:e28–9.

    Article  PubMed  Google Scholar 

  55. 55.

    Akkus NI, Mina GS, Fereidoon S, Rajpal S. Tattooing complicated by multivalvular bacterial endocarditis. Herz. 2014;39:349–51.

    CAS  Article  PubMed  Google Scholar 

  56. 56.

    Orton CM, Norrington K, Alam H, Alonso-Gonzalez R, Gatzoulis M. The danger of wearing your heart on your sleeve. Int J Cardiol. 2014;175:e6–7.

    Article  PubMed  Google Scholar 

  57. 57.

    Shebani SO, Miles HF, Simmons P, Stickley J, De Giovanni JV. Awareness of the risk of endocarditis associated with tattooing and body piercing among patients with congenital heart disease and paediatric cardiologists in the United Kingdom. Arch Dis Child. 2007;92:1013–4.

    Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Kluger N. Bacterial endocarditis and body art: suggestions for an active pre vention. Int J Cardiol. 2009;136:112–3.

    Article  PubMed  Google Scholar 

  59. 59.

    Hendren N, Sukumar S, Glazer CS. Vibrio vulnificus septic shock due to a contaminated tattoo. BMJ Case Rep. 2017;. doi:10.1136/bcr-2017-220199.

    Google Scholar 

  60. 60.

    Tendas A, Niscola P, Barbati R, Abruzzese E, Cuppelli L, Giovannini M, Scar-amucci L, Fratoni S, Ales M, Neri B, Morino L, Dentamaro T, De Fabritiis P. Tattoo related pyoderma/ectymagangrenous as presenting feature of relapsed acute myeloid leukaemia: an exceptionally rare observation. Injury. 2011;42:546–7.

    Article  PubMed  Google Scholar 

  61. 61.

    Trinh SA, Angarone MP. Purpureocillium lilacinum tattoo-related skin infection in a kidney transplant recipient. Transpl Infect Dis. 2017;19(3). doi:10.1111/tid.12689.

  62. 62.

    Silvestre JF, Albares MP, Ramón R, Botella R. Cutaneous intolerance to tattoos in a patient with human immuno-deficiency virus: a manifestation of the immune restoration syndrome. Arch Dermatol. 2001;137:669–70.

    CAS  PubMed  Google Scholar 

  63. 63.

    Kluger N. Leishmaniasis in Spanishtattoos. Enferm Infecc Microbiol Clin. 2010;28:667.

    Article  PubMed  Google Scholar 

  64. 64.

    Khair K, Holland M, Pollard D. The experience of girls and young women with inherited bleeding disorders. Haemophilia. 2013;19:e276–81.

    CAS  Article  PubMed  Google Scholar 

  65. 65.

    Kluger N. Body art and pregnancy. Eur J Obstet Gynecol Reprod Biol. 2010;153:3–7.

    Article  PubMed  Google Scholar 

  66. 66.

    Schreiver I, Hesse B, Seim C, Castillo-Michel H, Villanova J, Laux P, Dreiack N, Penning R, Tucoulou R, Cotte M, Luch A. Synchrotron-based ν-XRF mapping and μ-FTIR microscopy enable to look into the fate and effects of tattoo pigments in human skin. Sci Rep. 2017;7(1):11395. doi:10.1038/s41598-017-11721-z.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Nicolas Kluger.

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Nicolas Kluger is an honorary member of the French Tattoo Union. Christa De Cuyper has no conflicts of interest to declare.

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Kluger, N., De Cuyper, C. A Practical Guide About Tattooing in Patients with Chronic Skin Disorders and Other Medical Conditions. Am J Clin Dermatol 19, 167–180 (2018). https://doi.org/10.1007/s40257-017-0326-5

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