Can You Get a Tattoo If You Have Psoriasis?

What you need to know about possible risks

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Psoriasis is an autoimmune disorder primarily affecting the skin. Symptoms tend to occur in episodes, known as flares, which may be triggered by events such as stress, infection, medications, or skin injuries.

Even old scar tissue, like tattoos, can suddenly become the site of a flare. On one day, a tattoo may appear perfectly normal, and, the next, the tissues may begin to swell and flake, spreading outward to adjacent skin.

But, does this mean you should forget about getting a tattoo if you have psoriasis? If not, is there a safe way to get one?

Skin Trauma and Psoriasis

Psoriasis is a condition that accelerates the growth of skin cells called keratinocytes. The acceleration causes the cells to build up faster than they can be shed, leading to the formation of scaly patches called plaques.

Psoriasis flares may be idiopathic (of unknown origin) or activated by any number of triggers. One of the more common but least understood triggers is an injury to the skin These include cuts, scrapes, burns, sunburns, insect bites, and puncture wounds. Even irritation caused by a tight belt or a shoulder strap may trigger a flare.

According to a 2013 review in the Canadian Medical Association Journal, around 25 percent of people with psoriasis will experience a flare as a result of skin trauma.

This effect is commonly known as the Koebner phenomenon (or simply the Koebner response). Named after the 19th-century dermatologist Heinrich Köbner, the phenomenon is defined as the appearance of skin lesions along the site of a trauma.

In addition to psoriasis, there are other conditions associated with a Koebner response, including:

Hypotheses

Despite knowing about the Koebner phenomenon for more than a century, scientists remain uncertain as to why it occurs. At its heart, the Koebner response describes the body's overreaction to an injury. It can occur with autoimmune disorders (such as psoriasis) as well as ones unassociated with autoimmunity (such as Kaposi sarcoma)

One theory suggests that the Koebner phenomenon occur when the outer and middle layers of the skin (known respectively as the epidermis and dermis) are simultaneously injured.

When this occurs, the immune system will send defensive cell (such as T-cells and cytokines) to the site of the injury aid in the repair. By doing so, the resulting inflammatory response may inadvertently trigger disease activity in those tissues.

With psoriasis specifically, the immune response may activate not only the antibodies that attack foreign organisms but the autoantibodies that attack normal cells.

The hypothesis is evidenced in part by psoriasis flares in people who have undergone radiation therapy and have deep bruising. Although the epidermis may remain uncompromised, the underlying dermis will have sustained enough injury to incite an autoimmune response.

Even the inflammation caused by vigorous scratching may be enough to activate an abnormal immune response in some people.

Psoriasis and Tattoos

Based on what we know about psoriasis and the Koebner phenomenon, it makes sense the tattoos—which are essentially dyed scar tissue—can incite an autoimmune assault. But what about healed scars that suddenly develop psoriasis years later?

Interestingly, the period between a skin injury and the presentation of psoriasis can range from three days to two years, according to a 2011 study in Clinical Dermatology. There are even cases where tattoos created decades earlier will suddenly be the primary (and sometimes initial) site of a psoriatic flare.

What this suggests is that skin trauma is probably not the sole trigger of psoriasis or even a major one. Instead, other factors may instigate the onset of symptoms, while scar tissues may simply serve as convenient targets.

This may be due to the fact that keratinocytes behave differently in scar tissue. Rather than undergoing the normal 40- to 56-day life cycle where old cells are replaced with new cells, keratinocytes in scar tissue will persist and proliferate, causing the thickening of tissues known as epidermal hyperplasia. The rich population of keratinocyte receptors may serve as the obvious target should psoriatic disease develop.

Risks and Considerations

As concerning as these risks may be, it is important to note that tattoos don't always cause problems in people with psoriasis. Statistically speaking, there is a one-in-four chance of a Koebler response following a skin trauma, including tattoos.

With that being said, the risk may be significantly higher if you've ever experienced a flare following a cut, burn, or sunburn or develop psoriasis seasonally due to cold, dry weather.

In addition, tattoo dyes (particularly yellow and red dyes) may cause skin allergies that incite an autoimmune response. If you are prone to skin allergies, consider getting a patch test beforehand to see how your skin reacts to the ink.

If you experience a flare after getting a tattoo, see a dermatologist. Depending on the severity of symptoms, you may be prescribed a topical steroid or other treatments to relieve pain and inflammation.

A Word From Verywell

Make every effort to check out a tattoo parlor before getting a tattoo. Some facilities will not serve customers who have an inflammatory skin condition, regardless of whether the disease is active or not. Furthermore, some state laws prohibit parlors from tattooing people with skin conditions.

If you decide to get a tattoo, consider having it done in stages. If possible, start with a small tattoo you can live with, and schedule additional procedures every three to six months if your skin remains clear.

It is also a good idea to check the state laws regarding tattoo sanitation, including the use of protective gear, disposable needles, and sterilization equipment. Most states require some form of licensing which you should check in advance of your appointment.

Finally, and perhaps most importantly, speak with your dermatologist before getting a tattoo to fully weight the pros and cons based on your medical history and personal risk factors.

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