Isotretinoin and tattooing: a cautionary tale

Tattooing in Psoriasis: A Questionnaire-Based Analysis of 150 Patients

Purpose

Among populations of Western countries, tattoos have become an accepted form of skin ornamenting. With tattoos growing in popularity, also patients suffering from chronic dermatoses may more often be willing to get tattooed. Psoriasis is not considered as a strict contraindication for tattooing; however, it is not advised to get a tattoo while undergoing immunosuppressive treatment and during an active stage of the disease. We attempted to assess the knowledge level of tattooed psoriatic patients about the potential risks connected with tattooing, as well as to explore their attitudes and tendencies towards this procedure. Moreover, we analyzed the frequency and type of tattoo complications in this study group.

Patients and Methods

An anonymous, online questionnaire was performed among online communities dedicated to psoriasis. Data from 150 tattooed psoriatic patients have been scrutinized.

Results

Eight percent of the surveyed psoriatic patients sought medical advice before getting a tattoo. While undergoing the tattooing procedure, 23 (15.3%) of the respondents received systemic psoriasis treatment: 8 (5.3%) being treated with methotrexate, 5 (3.3%) with cyclosporine A, one (0.7%) acitretin, and 9 (6%) patients were under biological treatment. Thirteen (8.7%) of the participants experienced complications associated with their tattoos, among which, the insurgence of the Koebner phenomenon on the tattoo, was the most frequent one (8 cases- 5.3%). Getting tattooed improved patients' self-esteem in 76 (50.7%) of the cases.

Conclusion

An increased level of education among patients, medical practitioners, and tattooists concerning general precautions of tattooing in psoriasis is advisable.

How to advise a patient who wants a tattoo?

Tattooing and permanent make-up have become mainstream procedures. Many factors play a role in the final outcome of a tattoo and the satisfaction of the customer. The technical and artistic skills of the tattooist will determine the esthetic result and will help to guide the customers in their decision and choice of the tattoo. Although tattooing is by many considered as safe one should be are aware of the risks of complications related to this body modification technique. Some customers have a medical problem and some doubt about the safety of the procedure. People with increased risk of adverse events often seek medical advice prior to decide to get a tattoo or PMU. Physicians should not only be informed about the medical history of their patients but also have some basic knowledge of the practice of tattooing and the effects this procedure can exert on the skin and on the health condition of the patient. Contraindications and special precautions with regard to skin diseases and specific systemic conditions will be addressed in this article.

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

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.