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Tattoos: 7 unexpected skin reactions and what to do about them


Even if you get inked by a licensed tattoo artist and follow the aftercare, your skin can react in weird and unexpected ways. Some reactions happen immediately. Others take weeks or years to appear. If you’re having a reaction, here’s what may be happening and what you can do.

  1. Infection

    An infection in a new tattoo made of gray ink, which the tattoo artist created by mixing black ink with tap water.
    When it’s likely to appear: An infection can happen:

    • Immediately after getting a tattoo
    • Days or months after getting inked

    Signs of an infection: After getting a tattoo, it’s normal to see some redness and swelling. Your skin will feel sore, and you may see clear fluid oozing from your new tattoo. As your skin heals, it can itch and flake. Scabs may form. All of this can be part of your normal healing process.

    If an infection develops, your skin reacts a bit differently. You may notice one or more of the following:

    • Redness: It becomes darker or spreads instead of lightening and diminishing
    • Pain: It continues or worsens instead of subsiding
    • Rash of itchy, red, and painful bumps develop within the tattoo
    • Fever
    • Chills and shivering
    • Pus in the tattoo
    • Open sore(s) in the tattoo
    Take action: If you have any signs or symptoms of an infection, see your doctor or a board-certified dermatologist right away. The sooner treatment is started, the less damage it can do to your health and your tattoo.

  2. Rash: Allergic reaction to an ink

    Seventeen years after getting this tattoo, a woman developed an allergic reaction to the red ink.
    When it's likely to appear: You can develop an allergic reaction at any time. It can happen:

    • Immediately
    • Weeks or years later
    • Decades afterward
    Some people develop an allergic reaction after having a medical treatment. This reaction is most likely to occur if you:

    • Start antiretroviral treatment for HIV
    • Have joint-replacement surgery
    Signs of an ink allergy: Most people develop an allergy to a specific color of ink. Red is often the culprit, but any color can cause an allergic reaction. When this happens, you may notice one or more of the following in only one color of ink:

    • Redness and swelling
    • Itch
    • Small pimple-like bumps
    • Raised, scaly patches
    • Deep lumps
    • Blisters
    • Skin crusts or flakes off
    • A watery fluid leaking from the area

    Take action: If you suspect that you're having an allergic reaction, dermatologists recommend the following:

    • Serious reaction: Seek immediate medical care.
      Signs of a serious reaction: You see a reaction in your tattoo and have one or more of the following: Trouble breathing, a racing heart, tightness in your chest, dizziness or lightheadedness, a stomachache, intense swelling, serious pain, flushing, or hives.
    • Mild or moderate reaction: Tell your tattoo artist about the reaction, and ask if there’s anything you should do. If the reaction lasts longer than 1 or 2 weeks, see a board-certified dermatologist.
      Signs of a mild or moderate reaction: You have a noticeable change within your inked skin, but you don’t have any symptoms that affect another part of your body, such as trouble breathing or a stomachache.

  3. Rash: Temporary tattoo

    Within 24 hours of getting a henna tattoo on his neck, this man developed intense itch, redness, swelling, and tiny bumps.

    When it's likely to appear: A reaction can occur at any time between getting a tattoo and 3 weeks later.

    The allergic reaction is usually caused by a black dye. Many people have an allergic reaction to black dye that contains a chemical called PPD.

    Signs of a reaction: If you or your child has an allergic reaction, you may notice one or more of the following in the temporary tattoo:

    • Redness and swelling
    • Intense itch
    • Pain
    • Tiny bumps
    • Scaly, raised skin
    • Blisters, which may open and leak
    • Loss of skin color
    • Scarring
    A few people have developed problems, such as dizziness, fainting, or a stomachache.

    Take action: Dermatologists recommend the following:

    • Serious reaction: Get immediate medical care.
      Signs of a serious reaction: You see a reaction in your tattoo and have one or more of the following: Trouble breathing, a racing heart, tightness in your chest, dizziness or lightheadedness, a stomachache, intense swelling, serious pain, flushing, or hives.
    • Mild reaction: If it lasts longer than 1 week, see a board-certified dermatologist.
      Signs of a mild reaction: You see a reaction within the tattoo but don't have symptoms in other areas of your body.

  4. Rash: Sun allergy

    If you develop an itchy rash on your inked skin when outdoors, you may have a sun allergy.
    When it’s likely to appear: After getting a tattoo, some people develop a sun allergy on their inked skin. This reaction can happen every time the sun’s rays hit your tattoo.

    Signs of a sun allergy: This allergy can appear within minutes of the sun hitting your tattoo or hours later. You may have a sun allergy on your inked skin if you notice any of the following:
    • Swelling and redness around a tattoo
    • Itchy rash of tiny bumps
    • Blisters or hives
    Take action: You can prevent a rash by protecting your skin from the sun. To protect your tattoo and your skin, dermatologists recommend that you:
    • Apply sunscreen 15 minutes before going outside. To get the protection you need, use a sunscreen that offers SPF 30 or higher, broad-spectrum protection, and water resistance. You should apply sunscreen to all skin that will be exposed while you're outdoors.
    • Cover your tattoo with clothing before going outdoors. To test how well the clothing will protect your skin, hold the clothing up to a bright light. If you cannot see light through the fabric, the clothing offers good sun protection. Dermatologists still recommend applying sunscreen to all skin that will be bare while you’re outside.
    • Seek shade. Staying in the shade is a simple way to reduce sun exposure.

  5. Skin disease appears

    Getting a tattoo can trigger some conditions, such as psoriasis or eczema, to appear in or around the tattoo.
    When it’s likely to appear: If you carry the genes for psoriasis, getting a tattoo can trigger a psoriasis flare or cause psoriasis to appear for the first time. Other skin diseases can also appear within or around a tattoo.

    If a skin condition that appears, you’ll likely see signs of the disease within 10 to 20 days of getting the tattoo. The disease can also appear as early as three days after getting inked. Sometimes, it shows up years later.

    Skin cancer can also form within a tattoo.

    Signs of skin disease: Around the tattoo, you may see signs of one of the following skin conditions:
    • Psoriasis
    • Eczema
    • Vitiligo
    • Lichen planus
    • Keloid
    • Sarcoidosis
    • Scars
    • Skin cancer
    Take action:
    • If you have a tendency to scar or have ever had a scar that grew bigger than the wound causing it (a keloid), rethink getting a tattoo. Scarring can ruin the appearance of your tattoo.
    • If you’ve already developed a scar or signs of a skin disease, make an appointment to see a board-certified dermatologist. A dermatologist can minimize the look of a scar, diagnose a skin disease, and develop a treatment plan for a skin disease. Find a dermatologist.

  6. MRI burn

    If you have a tattoo or permanent makeup, be sure to tell the technician before having an MRI.
    When it’s likely to appear: While rare, a few people have developed a burn on tattooed skin during an MRI.

    Signs of a reaction: If the ink used to create a tattoo or permanent makeup causes a burn, it’s likely to be mild. A few serious burns have been reported.

    If you have a minor burn, it can cause:
    • Pain
    • Redness
    • Swelling
    Take action: If you have a tattoo or permanent makeup, you can still get an MRI. Doing the following can help prevent a burn:
    • Tell the technician who is giving you the MRI that you have tattooed skin or permanent makeup.
    • Ask the technician to stop the MRI if you feel burning or stinging during the MRI where you have a tattoo or permanent makeup.

  7. Swollen lymph nodes

    Researchers have found that inks used to create tattoos and permanent makeup can spread inside your body, causing long-term swelling in nearby lymph nodes.
    When it’s likely to appear: Ink usually spreads to the lymph nodes as your skin heals from getting the tattoo.

    Signs of a reaction: Swelling in lymph nodes, usually near a tattoo. The largest groups of lymph nodes are found in your neck, armpits, and groin.

    Take action: If you feel long-term swelling in any lymph nodes, dermatologists recommend that you:
    • See your primary care doctor to rule out another possible cause. Swollen lymph nodes could be a sign of an infection or another health concern.

How to find a dermatologist in your area

If you need a dermatologist, you can find one who practices in the United States, Canada, Mexico, or another part of the world at Find a dermatologist.


Images
Images 1-3: Used with permission of the Journal of the American Academy of Dermatology.

  • J Am Acad Dermatol. 2010;62(3):501-6.

  • JAAD Case Reports 2015;1(6):395-8.

  • J Am Acad Dermatol. 2003;48(2):301-2.

Images 4-9: Getty Images

References
American Academy of Dermatology. “Dermatologist warns consumers about complications linked to newer tattoo inks.” News release issued March 1, 2013. Last accessed July 20, 2018.

Bjerre RD, Ulrich NH, et al. “Adverse reactions to tattoos in the general population of Denmark.” J Am Acad Dermatol. (2018), doi: 10.1016/j.jaad.2018.03.038. [Epub ahead of print]

Brady BG, Gold H, et al. “Self-reported adverse tattoo reactions: a New York City Central Park study.” Contact Dermatitis. 2015;73:91-9.

Cobb HK, Shinohara MM, et al. “Systemic contact dermatitis to a surgical implant presenting as red decorative tattoo reaction.” JAAD Case Reports. 2017;3:348-50.

Deinlein T, Arzberger E, et al. “A dangerous fruit of Belladonna.” J Am Acad Dermatol. 2016;75:e93-e94.

Drage LA, Ecker PM, et al. “An outbreak of Mycobacterium chelonae infections in tattoos.” J Am Acad Dermatol. 2010;62:501-6.

Gamba CS, Smith FL, et al. “Tattoo reactions in an HIV patient: Autoeczematization and progressive allergic reaction to red ink after antiretroviral therapy initiation.” JAAD Case Reports. 2015;1:395-8.

Goldenberg A, Jacob SE. “Commentary: Paraphenylenediamine in black henna temporary tattoos: 12-year Food and Drug Administration data on incidence, symptoms, and outcomes.” J Am Acad Dermatol 2015;72:724-6.

Guerra A, Chavez S, et al. “Poster: Mycobacterias in aesthetic tattoos as a late complication.” J Am Acad Dermatol. 2016;74 (suppl 1):AB152. Commercial support: None identified.

Patton T, Mori W, et al. “Poster: The tattoo artist’s approach to areas with melanocytic nevi (abstract).” J Am Acad Dermatol. 2017;76 (suppl 1):AB257. Commercial support: None identified.

Rosenbaum BE, Milam EC, et al. “Skin care in the tattoo parlor: A survey of tattoo artists in New York City.” Dermatology. 2016;232:484-9.

Shreiver I, Hesse B, et al. Synchrotron-based ν-XRF mapping and μ-FTIR microscopy enable look into the fate and effects of tattoo pigments in human skin. Sci Rep. 2017;7(1):11395.

U.S. Food and Drug Administration. “Temporary tattoos may put you at risk.” Page last updated Dec. 12, 2017.

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