Psoriasis and tattoos pictures

5 Things to Know About Tattoos if You Have Psoriasis

If you have psoriasis, it doesn’t mean you can’t get a tattoo. But there are things you should know before getting one to reduce your risk of psoriasis symptom flares, skin lesions, and other complications.

Psoriasis is an autoimmune disease that leads to a buildup of extra cells on the skin’s surface. Thick, scaly patches called plaques can develop, causing itchiness, burning, or soreness of the skin. People with psoriasis may think a tattoo will hide their condition, but tattoos likely won’t conceal patches and could in fact cause skin irritation or a worsening of symptoms.

RELATED: My Memories of Being a Teenager With Psoriasis

“Many patients want to hide certain skin-related conditions, so it’s a good question to ask your doctor if a tattoo could make your condition worse,” says Edward Prodanovic, MD, an assistant professor of dermatology at Eastern Virginia Medical School in Norfolk.

Here Dr. Prodanovic answers some common questions about the dos and don’ts of getting tattoos, especially if you’re one of the 7.5 million Americans living with psoriasis.

Q: Is Getting a Tattoo Safe for Someone With Psoriasis?

A: When somebody gets a tattoo, the artist inserts permanent ink of assorted colors into the skin with small punctures of a needle. Complications are relatively rare, but having an underlying disorder that affects the skin like psoriasis can raise the risk of having an immunological response to the ink. It may also prolong the healing time following the procedure. If you’re prone to skin allergies, consider getting patch tested before tattooing to see how your skin might react to the ink. Keep in mind that patch test results are not a guarantee of how your skin will react to a tattoo.

Q: What Are the Biggest Risks of Getting a Tattoo?

A: Tattoo ink contains various chemicals, such as aluminum, iron oxide, manganese, and mercury sulfide. These ingredients can cause an allergic reaction such as a rash or swelling. Yellow and some red tattoo inks that contain cadmium sulfide pose the greatest risk of a photoallergic reaction, which is triggered by exposure to sunlight.

Q: If You Have Psoriasis, Can Getting a Tattoo Cause Symptoms to Flare?

A: The risk for people with psoriasis is what we refer to as the Koebner phenomenon. Psoriasis plaques form at the site of a skin irritation or, in this case, a tattoo. It typically shows up in two to four weeks, but it can also occur months to years later. Not everyone with psoriasis will have this reaction. But if you have ever had a cut or burn that led to a psoriasis flare, then you may react similarly with a tattoo. If psoriasis plaques do develop, see your dermatologist.

Q: Are Henna Tattoos Safer?

A: Henna tattoos are nonpermanent, and they’re painted onto the skin with a brush resulting in a brownish stain. Henna is approved by the Food and Drug Administration only for use as hair dye, and black henna contains the chemical p-phenylenediamine, which can cause a severe skin reaction. Even though the process is less invasive than a traditional tattoo, there is still a risk of the Koebner phenomenon.

Q: What Should a Person Consider When Choosing a Tattoo Parlor or Artist?

A: Go to a tattoo artist who is licensed and a tattoo parlor that is registered. Any ink they use should be specifically approved for tattoos and not have expired. It’s important that the tattoo studio use proper sanitization processes. People with psoriasis can be more susceptible to infections following any injury to the skin. The tattoo artist may not be familiar with your condition, so inform them about it and make them aware of the risks.

PMC

Discussions

In 1877, the German dermatologist Heinrich Koebner formulated the first definition of Koebner phenomenon by describing the appearance of psoriatic lesions in uninvolved skin of psoriatic patients following local trauma . At present, the definition of this phenomenon has been extended, and it also refers to the appearance of lesions along a site of injury even in people without a pre-existing dermatosis . Koebner phenomenon, also known as isomorphic response, is seen in several other skin diseases, such as lichen planus and vitiligo. Some authors consider that a variety of other diseases including warts and molluscum contagiosum may koebnerize. However, in these conditions, there is not a “true” koebnerization as the occurrence of new lesions due to the seeding of an infectious organism at the site of trauma. “True” koebnerization refers to those diseases in which the pathogenesis of development of new lesions is identical with that of the main condition (psoriasis, lichen planus, vitiligo) .

Koebner phenomenon occurs in about 25% of people with psoriasis after various traumatic injuries, especially in the unstable period of the disease . The period from the injury to the appearance of new skin lesions is generally between 10 and 20 days, but may range from 3 days to 2 years . Various provoking factors have been reported to induce new psoriasis lesions including physical trauma, burns, friction, insect bites, surgical incision, allergic and irritant reactions, radiation exposure, medications and needle acupuncture trauma . Another factor that can induce the isomorphic phenomenon in patients with psoriasis could be the trauma produced by tattooing the skin. Despite the wide popularity of the tattoos, there are few reports in literature of tattoo-induced psoriasis . The relation between the tattoo “trauma” and psoriasis is still controversial with some authors considering that the occurrence of new lesions after this kind of trauma could be just the normal course of the disease.

In our case, the patient was diagnosed with scalp psoriasis several years prior to this event and he developed generalized lesions of psoriasis 2 weeks after tattooing. The tattoo procedure could have been the provocative factor for psoriasis. There are the 2 weeks onset interval in favor of this scenario and the localization of the psoriatic lesions on the tattooed skin. During the process of tattooing, the dye penetrates the papillary and upper part of the reticular dermis near blood and lymphatic vessels. It is difficult to determine whether the provocative factor for the Koebner phenomenon was the repeated needle trauma as described in acupuncture-induced psoriasis or the tattoo ink immune response.

Even though the pathophysiology of the Koebner phenomenon has not been entirely elucidated, it was demonstrated that nerve growth factor (NGF) influences the key pathological events in psoriasis and Koebner phenomenon: keratinocyte proliferation, angiogenesis and T-cell activation . In a developing a psoriatic lesion, the up-regulation of NGF together with keratinocyte proliferation are early events and precede epidermotropism of T lymphocytes; keratinocytes in patients with psoriasis are primed to produce elevated levels of NGF .

Current knowledge on psoriasis and autoimmune diseases

Introduction

Psoriasis is a prevalent, chronic inflammatory skin disease that affects approximately 0.5%–1% of children and 2%–3% of the world’s population.1 Psoriasis is a bi-modally distributed disease with one major age of onset at 20–30 years of age as well as a later smaller peak of onset at 50–60 years.2,3 Even though psoriasis etiology remains unknown, it is believed to be multifactorial with numerous key components including genetic susceptibility, environmental triggers in combination with skin barrier disruption and immune dysfunction.4 There are five subtypes of psoriasis: vulgaris (plaque), guttate, pustular, inverse, and erythrodermic. The most common variation of psoriasis is plaque psoriasis, which affects approximately 85%–90% of psoriatic patients.5

Psoriasis confers significant physical and psychological distress and impairment usually resulting in a detrimental impact on patient quality of life.6,7 Psoriasis patients often express feeling shame and guilt and are stigmatized by the disease.8 Psoriasis has been reported to affect the interpersonal relationships of patients as well as impacting sexual well-being and capacity for intimacy.9,10 In the work place, psoriasis has a negative social impact which may manifest as discrimination and difficulty finding employment. Nearly 60% of employed psoriasis patients reported lost time from work in the previous year due to psoriasis.11

Complications arising from psoriasis lead to numerous deaths in the United States annually.12 Perhaps the most detrimental aspect of psoriasis is the concurrent physical comorbidities such as cardiovascular disease (CVD), obesity, diabetes, metabolic syndrome, inflammatory bowel disease (IBD), and psoriatic arthritis that contribute to decreased longevity.13–16

Skin phenotype and histology of psoriasis

Phenotype

Plaque psoriasis is the most common presentation of the disease. It is phenotypically characterized by red, scaly, well-defined, silvery-white, dry plaques that preferentially appear on elbows, knees, scalp, and the lumbar area. The often symmetrical plaques can be erythematous and are often categorized by patients as itching intensely. Severity of the plaques is quantified by two major scoring systems; the psoriasis area and severity index (PASI) and the physician’s global assessment (PGA). The PASI scale allows quantification of the extent of disease as a measure of area and intensity (erythema, induration, desquamation, and body surface area). Given the complicated nature of the PASI calculation, the PGA was introduced as an alternative assessment measure. The PGA calculates either a static or dynamic global assessment of lesion severity.17 Interestingly, and a key feature of chronic plaque psoriasis, is the normal appearing “uninvolved” skin immediately adjacent to psoriatic plaques of affected individuals. Several recent studies have demonstrated that uninvolved tissue may contain a unique signature of genes, that when activated may account for the conversion of uninvolved skin to involved plaque. However, given the myriad cell types known to participate in this conversion, isolation of a single triggering factor is unlikely (Figure 1).

Figure 1 Key signals in psoriasis development.
Notes: Numerous cellular mediators and signaling pathways are activated in psoriatic lesions following diverse triggers. In the background of individuals expressing a favorable genetic predisposition toward a hyperactive immune response (quiescent panel), these mediators drive a proinflammatory response (flare panel). The proinflammatory state progressively overwhelms the immune counter-balancing mechanisms, and skin proliferation becomes uncontrollable by conventional regulatory cells and suppressive mediators (eg, Treg, IL-10, TGFβ; Chronic/recurrent panel). This exacerbated inflammation results in the progressive creation of resident memory self-reactive cells that in-turn contribute to recruiting inflammatory mediators that result in a life-long recurrent chronic inflammatory skin disease.
Abbreviations: CD8 CM, CD8 central memory; Treg, regulatory T cell; NK, natural killer; Th, T helper; TipDC, TNF-iNOS-producing DC; NETs, neutrophil extracellular traps.

Welcome to our tattoo gallery

Ashley | California

Tattoo: Her last name and the sun from the Filipino flag.

What it means: Located on the inside of her right wrist and forearm, the tattoo represents her Filipino heritage. “Soon after I got my tattoo I had some scabbing from my psoriasis, but I was glad that it didn’t affect how my tattoo turned out. I have plans to get more tattoos in the future now that I have a better idea how my psoriasis reacts.”

Amanda

Tattoo: She’s had it for four years.

What it means: “The area was covered with very small psoriasis for a short time while healing. I still love my tattoo. It’s just that my psoriasis decided to make sure it is unique. I was very worried while it was healing due to the rate it discolored, and even the tattoo artist didn’t know what to do. I did do my research beforehand so I knew it was possible that this could happen. I have no psoriasis in the area at the moment and it has seemed to settle back to what’s normal for me.”

Amaris | North Carolina

Tattoo: Love with a capital “L.”

What it means: “I wanted a daily reminder of what my life needed to be centered on. It makes arguments with family members rather fun as I, during tense and difficult moments…simply hold up my arm….It reminds us of what our motivator should be. The tattoo does not affect my psoriasis.”

Bonnie | Michigan

Tattoo: A critter constructed of music symbols, including a treble clef, bass clef and many quarter notes.

What it means: Located on her left shoulder, the tattoo relates to her love of music. She has had psoriasis since her childhood and was diagnosed with psoriatic arthritis in 2010. “I have not played my guitar since January due to the loss of my dexterity,” she said. ” I used to play at night and on weekends at a local restaurant. Since my diagnosis, I’ve quit my day job as the executive director of a local community center and I now freelance as a business writer and PR consultant.” Getting the tattoo in 2007 didn’t have any affect on her psoriasis, which was mild at that time, she said.

Mark | Kansas

Tattoo: Celtic Cross and a date that memorializes a friend.

What it means: “When things happen in my life, I’ll go talk with the tattoo artist and come up with a new idea,” said Mehrer, whose upper body is covered with tattoos. “I have developed a strong sense of spirituality, or purpose, so a lot of the tattoos are emblematic of that.” Mehrer doesn’t worry about aggravating his plaque psoriasis, which is confined mostly to his legs.

Patrick | Virginia

Tattoo: Cross, heart, anchor and nautical stars.

What it means: “The cross, heart and anchor are Faith, Hope and Charity. The hearts came off our wedding invites. The anchor is because my wife is in the U.S. Navy. The nautical stars are set similar to the Southern Cross, which is also on the Australian flag . The stars also have a meaning for sailors as a way to find their way home.”

Jennifer | Massachusetts

Tattoo: Skull and crossbones.

What it means: “My tattoo represents rage, fear, and passion. At one point in my life, I had 80 percent plaque psoriasis coverage. Psoriasis has taken a lot of my confidence, my hair at one point and my dignity at other times. I am thankful every day that injectable medications have done so well, and I am down to about 5 percent.”

Jody | Wisconsin

Tattoo: A music symbol entwined with her children’s initials.

What it means: “My kids are my life. I love music, music is life. I entwined them. My kids names are Brandon and Rebecca. There is a B on top and an upside-down 16th note. The R is on the bottom treble and base clef. I have always wanted a tattoo but was discouraged by my dermatologist. On my 40th birthday , I decided I was going to get a tattoo. I chose my left shoulder because, even in my worse case, my shoulder wasn’t bad.”

Kasi | Iowa

Tattoo: Pigtails, skull, heart and crossbones.

What it means: “Pigtails remind me it’s OK to be beautiful, sexy, feminine and girly. The skull shows that it’s OK to be strong. The heart reminds me to love fully without condition. The crossbones remind me there is a treasure at the end of the journey. I have had flare-ups many times on all three of my tattoos and it hasn’t affected any of them so far.”

Kimberly | Alberta, Canada

Tattoo: The words “Novem Quinque,” Latin for “September 5.”

What it means: “That is the date that I miscarried my baby in 2010. is all healed now and no signs of psoriasis yet. I was super nervous about getting it done because I notoriously develop psoriasis wherever I get injured. Part of the reason I chose my foot was so that it could be easy to cover up if I was to develop psoriasis there.”

Mary | Wisconsin

Tattoo: A paw print and, below it, the name of her late, beloved white German shepherd, Hailey.

What it means: Located on Mary’s ankle, the tattoo is a tribute to Hailey, who died Sept. 21, 2007. “About two weeks later, I had the tattoo done as a memorial to her life. I was diagnosed with psoriasis in June 2007 and had no idea about the Koebner effect when I got the tattoo. About two months after receiving the tattoo, I could see the start of psoriasis around it. Now the tattoo is unrecognizable, and it breaks my heart. I am a dog lover and had wanted to add to the tattoo as our beloved ‘fur kids’ passed on, but tattoos are no longer in my future.”

Melissa | California

Tattoo: Part of a favoriate love song written in kanji, a form of Japanese writing, surrounded by roses.

What it means: “It symbolizes the side of me which is a hopeless romantic and also the part of me that has been in love with Japanese culture since I was a child. I got the roses around the kanji just recently to represent the passing of several of my close friends,” she said. At first, psoriasis was not an issue, but throughout the past few years, she’s developed small patches in and around her tattoo. “In the past five years, despite having psoriasis, I have gotten into alternative modeling — meaning photos are a little more ‘out there,’ lots of people with brightly colored hair, piercings and tattoos!”

Robin | California

Tattoo: A wolf crying into the moon, with the word “Mom” under it.

What it means: Located on Robin’s right shoulder blade, the tattoo is a memorial to her mother, who died three years ago. “She was my rock. It was the hardest thing ever to deal with. I wanted to have a memorial tattooed on me for her. She loved wolves and yellow roses. The tattoo artist did a great job of incorporating those two thing,” she said. Robin also has a tattoo on her ankle with her son Darrin’s name. Psoriasis “pops up” from time to time in her “Mom” tattoo and psoriasis “completely attacked” her ankle tattoo. “It is huge disappointment, because tattoos are artwork and it seems like such as waste when the psoriasis attacks.” Because of her psoriasis, she won’t get any more tattoos.

Stephanie | California

Tattoo: Her father’s initials and an Emily Dickinson quote.

What it means: One of three tattoos, this one wraps around her right bicep and is a memorial to her father. She also has a tattoo on her outer left thigh featuring flowers and a Virginia Woolf quote, and the word “hope” tattooed on her left wrist. Stephanie has plaque and guttate psoriasis, but chose to get tattoos despite the risk of further irritating her skin. “It’s worth it to me because I see something that I like on my skin,” she said.

Psoriasis plaques on back

For people who face skin conditions, life can be tough. Make sure you really do the proper research before stepping into the tattoo parlour.

Can You Get a Tattoo?

Just because you have been diagnosed with psoriasis, it does not mean that you can’t get some ink done! There has been a lot of research done into the areas of tattoos and psoriasis, and both doctors and tattoo artists have been conducting studies on how psoriatic skin reacts to the tattoo gun. However, if you have psoriasis, getting a tattoo can be a challenge.

Avoid Ink Over Plaques

Tattoo artists cannot ink over plaques because this skin is constantly changing and is not your true skin. If your body is covered in plaques and the silver-white skin known as scales, a tattoo shop will probably turn your business away. You will not get the best tattoo results by tattooing over any skin that is abnormal.

The Koebner Effect

Along with the fact that getting tattooed over psoriasis plaques is a no-no, another issue with tattoos and psoriasis is the Koebner effect. This states that any injury to your skin can cause additional psoriasis plaques to show up where your skin was injured. This can happen from something as simple as nicking yourself with a razor, and since tattoos are much larger and more invasive than this – the chance is great that you may end up with a huge plaque in place of your tattoo. Not all psoriasis sufferers have this effect, however, so it is very difficult to predict.

Predicting Reactions

Not everyone with psoriasis will have a reaction when getting inked. However, there is no way to predict what will happen. Consider the following before you head to the tattoo shop:

  • Family History: Has any relative had psoriasis and also tried a tattoo? Their experience may give you some hints of what yours could be.
  • Current Skin Reactions: What causes psoriasis to flare up? If you cut yourself with a razor while shaving, does your skin react? If so, it is likely to do the same with the tattoo gun.
  • Severity of Your Condition: The more severe your condition, the more likely your skin will negatively react to a tattoo.

Professional Advice

If you have psoriasis, be sure to consult your doctor or other medical professional before getting inked. They will know your history and provide a more personalized guide to the potential for a negative reaction. Tattoo artists are not medically trained, and while they do have some intimate knowledge of the skin, cannot predict how your body will react. Psoriasis can be serious, so it is important to get medical clearance before getting that tattoo.

You want a tattoo—but you have psoriasis. Is it safe? There are some special considerations and risks. However, with proper planning and precautions, it is possible.

Understanding the risks

The biggest risk in getting a tattoo when you have psoriasis is the Koebner phenomenon. This is when psoriasis plaques occur at the site of a trauma to the skin. About 25 percent of people with psoriasis experience this as a result of a cut, injection, insect bite, sunburn, or other trauma to the skin according to a report in CMAJ. For the majority of people with psoriasis, a tattoo will not be the cause of increased psoriasis plaques.

Another risk of getting a tattoo is the increased chance of infection. Some people with psoriasis take immunosuppressant medications, increasing the risk of infection because the immune system is weakened and unable to fight off bacteria and viruses. But even those who don’t take these medications are more prone to developing infections. A study published in 2011 found that the rise in the level of infections in those with psoriasis was independent of whether immunosuppressant medications were used.

An analysis published in the March 2016 issue of Dermatology and Therapy reviewed 18 studies and concluded that the red ink used in some tattoos can cause negative skin reactions. Allergic reactions to both black and red ink can also be triggered by sun exposure, according to a Danish study included in the analysis. (All of the research examined in the analysis focused on the general public, not specifically on people with psoriasis.)

Taking precautions

It’s important to know your triggers. If you have experienced the Koebner phenomenon in the past, you have more of a chance of it occurring again. While some people decide it is worth the risk and treat the plaques immediately, others decide that the risk of developing psoriasis plaques on the area of the tattoo is not worth it and decide to forego a tattoo.

You should avoid getting a tattoo in the midst of a flare. This can aggravate your psoriasis and even if you haven’t experienced Koebner phenomenon in the past, this might increase the risk of it occurring. Some states have laws regarding getting a tattoo when you have a skin condition; for example, in Louisiana the law states that you can’t get a tattoo if there is evidence of psoriasis or eczema in the area of the tattoo.

Some medications might prevent you from getting a tattoo. Topical steroids thin the skin, which can lead to excessive bruising and tearing of the skin making getting a tattoo painful. Blood thinners could cause you to bleed more than normal and retinoids can cause excessive scarring. Before getting a tattoo, talk to your doctor about how your medications might interfere with the process.

Some people with psoriasis and other skin conditions opt to start small. This gives them the chance to see how their body reacts. For many people with psoriasis, getting a tattoo doesn’t cause any additional problems. The National Psoriasis Foundation has a tattoo gallery to give you ideas on what other people with psoriasis have chosen.

Choosing a tattoo shop

It’s important to prepare before getting a tattoo. Always make sure you are choosing a reputable tattoo parlor. Verify that the shop and all tattoo artists are properly licensed and have gone through any required training for your state and locality. Look around to make sure the shop looks clean. Some questions you can ask include:

  • Do all artists wear gloves when giving a tattoo?
  • Have tattoo artists completed a course in blood-borne pathogens?
  • Are the inks poured into a container and used for only one person?
  • Are fresh needles used for each individual?
  • Are all instruments sterilized properly after each use?

After getting your tattoo

Discuss the proper care of a tattoo with the artist before you leave the shop. You should also receive a written sheet of instructions. Make sure to always follow instructions for caring for a tattoo and continue with the care until it is completely healed.

While your tattoo is healing, it will swell and be itchy. But if you notice redness, oozing or excessive swelling, contact your doctor immediately as these are possible signs of infection. If you notice plaques at the site of the tattoo, call your doctor for immediate treatment.Plaques caused by the Koebner phenomenon should be treated the same as any other psoriasis plaque.

See more helpful articles:

The Koebner Phenomenon: Managing Cuts, Scrapes and Other Skin Irritations When You Have Psoriasis

How to Care for Your New Tattoo

7 Common Triggers for Psoriasis

Choosing the Best Treatment for Your Psoriasis

8 Myths About Psoriasis

Many people like to express themselves in the form of body art. If you have psoriasis, however, it’s worth thinking about the additional risks that may be involved if you decide to go down this route. Although it’s possible to get a tattoo if you experience psoriasis, it may not always be a wise decision for everyone.
The main issue with getting a tattoo if you have psoriasis is that the procedure breaks the skin, thus causing trauma to the surrounding area. Skin trauma can be a trigger for psoriasis flare-ups in some people.
In one-in-four people with psoriasis, getting a tattoo causes psoriasis lesions to develop at the tattoo site. This is known as the Koebner phenomenon . In some cases, this can happen within a few days or weeks after having the procedure, but it may even appear years later.
Unfortunately, there is no real way of knowing which sufferers of this skin disease may be vulnerable to the Koebner phenomenon following a tattoo. If you tend to develop psoriasis patches after getting cuts or grazes to the skin, this may suggest you could be prone to this phenomenon.
Another possible consequence of having a tattoo if you suffer from a skin disease like psoriasis is that the tattoo may become discoloured.
If you do decide to get a tattoo, it’s a good idea to speak to your doctor or dermatologist first for relevant advice, so you can properly weigh up the risks together. Be certain that you aren’t just getting a tattoo to cover up any psoriasis patches.
Choose your tattoo artist with care, and make sure they follow robust health and safety procedures. You should mention that you have psoriasis to the tattoo artist. In some cases, you may be advised to change the location where you want the tattoo if lesions are present, or you may be advised to wait if you are currently experiencing a flare-up. It’s worth bearing in mind that some tattoo artists may not carry out the work on people with psoriasis.
As you don’t know how your psoriasis will react from the tattooing procedure, it’s a good idea to only get a small one done initially to see how your body reacts. If lesions do develop on the skin following a tattoo, consult your doctor or dermatologist for appropriate psoriasis treatment to help clear the patches up.

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