Tattoos and Autoimmune Disease

Considerations Before Getting a Tattoo

If you live with a chronic or autoimmune disease such as inflammatory bowel disease (IBD, Crohn’s disease, or ulcerative colitis), lupus, multiple sclerosis, arthritis, or psoriasis, you may be wondering if it is wise to get a tattoo. Whether or not it is safe to get a tattoo is a discussion that is best had with a health care professional. There are several ideas to consider, including if the disease or condition is well-controlled and if there is an increased risk of developing a complication (such as an infection). In all cases, tattooing should only be performed by a licensed, experienced professional in a reputable location who uses sterile equipment.

A female tattoo artist working on a customer
CommerceandCultureAgency/Taxi/Getty

When Tattoos Go Beyond Art

Tattoos may have a significance for some who receive them as an expression of their values and beliefs. Tattoos are an ancient practice and they are incorporated into cultural and religious practices around the world.

People who live with chronic illness who may receive a tattoo as part of their culture may wish to consult health care providers in order to assess and minimize any potential risks. In the instance that a tattoo is part of a tradition, it’s important for health care providers and tattoo artists to respect how body art is important to a person’s identity.

There’s a theory that short-lived exposure to stress, such as when getting a tattoo, could be beneficial for the immune system. The authors of one study made a comparison between the immune response of getting a tattoo with the beneficial stress that comes from regular exercise. They point out, however, that tattooing doesn't have the same beneficial impact as vaccines or exercise and that people with tattoos still need to care for their health appropriately. Whatever the reason for receiving a tattoo, it’s important to consider and be prepared for the potential risks.

General Considerations

Tattoos are not without risk, even for people who don’t live with autoimmune disease or chronic illness. People who live with chronic conditions or autoimmune diseases often go through cycles with their health. There are times when the condition is well-managed and others when it is less controlled. When there is a disease process that’s not under control, it is probably not the best time to consider body art.

Depending on a number of factors, including the type of condition(s), the medications needed, and one’s general health, there could be increased risks from getting a tattoo. It may be better to wait until the condition is more stable before scheduling a tattoo session.

There is at least one case report, published in the British Medical Journal Case Reports, of a woman who experienced muscle inflammation after having a tattoo on her thigh. It was her second tattoo, the first being completed some years earlier without incident. She was a lung transplant recipient and lives with cystic fibrosis. She was also receiving immune-suppressing medications post-transplant and to manage her chronic illness. The woman, who lives in Scotland, was referred to a rheumatologist with muscle pain and swelling of 10 months’ duration that began about a week after receiving the tattoo. Providers were not initially connecting the tattoo to the pain but later made the association because the problems started about a week after the tattoo was completed and there were no other reasons found for the pain (such as trauma). The authors of the case report are not able to definitively point to the exact cause of the pain, but hypothesize that it could be related to a bacteria being introduced into the muscle, or as a reaction to the ink. Treatment with physiotherapy helped resolve the pain and inflammation.

Sanitary Practices and the Risk of Infection or Disease

The process of tattooing involves injury to the skin, which may open it up to infection. Infection is one of the more common risks of tattoos, especially those done at home or in unlicensed facilities. People who live with autoimmune disease and already have a compromised immune system, or whose immune system is suppressed through medication, may be at increased risk of infections.

The body is less able to defend itself against bacteria when there is active inflammation or a lowered immune response. People who live with autoimmune conditions will want to ask about and follow the after-care instructions from the tattoo artist carefully and consult a health care provider (such as a dermatologist) at the first sign of infection.

Even when a tattoo is performed in a reputable facility, bacteria that live on the body may get under the skin during the process. During healing, the tattooed area may be itchy, and scratching it could lead to bacteria getting under the skin and causing infection. Equipment, ink, or needles that are not kept sterile or are re-used can become contaminated and lead to infection with bacteria such as Staphylococcus aureus. Cases of fungal infection have been reported also, but these appear to be rare.

Another risk of receiving a tattoos in a non-sterile environment or with used equipment is in contracting a blood-borne disease, such as hepatitis. In the United States, hepatitis C is the leading cause of liver cancer. There have been no reported outbreaks of hepatitis C among professional tattoo parlors where sterile equipment is used. For tattoos given in a nonprofessional setting (at home or in prison, for example) the risk increases significantly. According to The Centers for Disease Control and Prevention (CDC), there are no documented cases of HIV being transmitted through tattooing. However, there is a theoretical risk if sanitary practices are not used during the process.

Skin Conditions

A common concern about getting a tattoo is developing a skin condition or worsening an existing skin condition. 

Allergic contact dermatitis. A retrospective analysis showed that allergic contact dermatitis after having a tattoo was rare (at a rate of less than 0.08%). More than half of those who had a reaction had some type of allergic response in the past. Allergic contact dermatitis occurs more often with certain colors used for tattoos, such as red, and typically presents as raised areas within the tattoo.

Keloids. Keloids are a type of scar that grows when the skin is broken (like getting a tattoo). The skin repairs itself aggressively and the result is the formation of a large scar. People who have had keloids in the past may be at risk for developing one after receiving a tattoo. Removing tattoos is also associated with the formation of keloids.

Granulomas and sarcoidosis. One way the body tries to and protect itself from a perceived irritant is by forming a granuloma around it. A granuloma on the skin may look like a lump of tissue. It’s thought that the granulomas form around the ink used in tattoos. They may show up years after a tattoo is placed. Sarcoidosis is a rare condition where many granulomas grow. Some people have been diagnosed with sarcoidosis after having granulomas form around their tattoos and it’s generally recommended that people already diagnosed with sarcoidosis not receive tattoos.

Erythema nodosum and pyoderma gangrenosum. These two skin conditions are exceedingly rare with tattoos. When they do occur, they cause lesions and are often associated with IBD or other chronic conditions. Pyoderma gangrenosum, in particular, can cause deep ulcers that are difficult to treat. Erythema nodosum tends to come and go, and get worse when the underlying autoimmune condition is flaring up. Because both of these conditions sometimes result after there has been trauma, like a needle prick, to the skin, it may be recommended by health care professionals that people who are prone to them not get tattoos.

Psoriasis. Psoriasis is a chronic skin condition that causes a rash that appears red with white scales. Some health care providers may recommended that people who live with psoriasis not receive tattoos. This is because it’s thought that the trauma to the skin caused by a tattoo could cause psoriatic lesions to develop in that area. In some cases, tattoo artists may be hesitant to work on clients who have active psoriasis, especially in an affected area of the body. People with psoriasis will want to consult with their health care team and consider their individual risk before getting a tattoo.

Tattoos and MRIs

There are some accounts of people experiencing burning or swelling at the site of a tattoo while undergoing magnetic resonance imaging (MRI). Some tattoos may also affect the quality of an MRI image. For those who undergo MRIs as a regular part of managing their condition, it is worth keeping this potential adverse effect in mind. It’s not common for these problems to occur. However, it may make sense to avoid getting a tattoo on a body part that might need regular monitoring with an MRI. An MRI should not be avoided or put off because of the potential for a reaction: it is not common and it's usually more important that the MRI be done. In addition, patients should always tell radiology staff about any tattoos before an MRI.

Why Ink Color May Matter

The exact extent of adverse reactions to tattoos is not well-understood in the United States. The color of the ink may be related to the risk of inflammation, allergic reactions, and hypersensitivity, because of certain ingredients, including chromium in green ink, cadmium in yellow ink, mercury salt in red ink, and cobalt in blue ink. In one study of people with tattoos who were selected at random in New York City’s Central Park, 10% had an adverse reaction to a tattoo. For 42% of those who described the reaction as related to the colors used in the tattoo, red was the culprit. While 90% of those surveyed had black ink in their tattoos, only 25% reported a reaction. The authors of the study conclude that such reactions to tattoos are common.

Testing the ink with a patch test on the skin may or may not be helpful. People who had a reaction to a tattoo who were later given a patch test with red ink did not have the same reaction. It’s thought that the process of receiving the ink during the tattoo process is different enough from a patch test that they are not equivalent. However, reputable tattoo artists will help with completing patch tests when clients have a concern about an allergic reaction. 

The Importance of Aftercare

It’s worth noting that tattoo artists should offer some guidelines about skin care after receiving a tattoo. According to one study of licensed tattooists in New York City, 56% received training on tattoo-related skin conditions but 92% were consulted about skin issues by their clients. Most tattoo artists are interested in learning more about skin conditions related to tattoos, however, with only about half reporting being trained, it’s important to note that adverse reactions may need to be evaluated by a dermatologist.

Some tips to keep in mind before and after getting a tattoo:

  • Seek out a reputable, licensed tattoo artist and ask questions about tattoos and autoimmune conditions.
  • The skin in the area to be tattooed should be disinfected before starting.
  • Tattoo artists should wear gloves while working.
  • Equipment used should be from sealed packages to ensure they are sterile and only used once.
  • Non-disposable equipment should be cleaned using a machine that sterilizes them with heat (an autoclave).
  • After the tattoo is complete, keep the area clean with soap and water, avoid exposing it to the sun, use a moisturizer, and don’t go swimming.
  • Don’t scratch or pick at any scabs that form on the tattoo.
  • It can take a few weeks for a tattoo to heal and so it’s important to continue any aftercare instructions during that time. 

A Word From Verywell

While the list of potential complications from tattooing can seem long, the best way to minimize these risks is to seek out a professional, licensed tattoo studio that uses hygienic practices. People who live with a chronic illness may need to take special precautions when receiving a tattoo. It’s always a good idea to consult a health care provider and understand one’s own individual risk.

There may be times, such as during a flare-up or when recovering from surgery, when it is best to hold off on any tattoos until the chronic illness is better controlled. For some people, it may be better to decide not to get any tattoos at all if it’s determined that the risks of a serious complication are too high. Even so, many people with autoimmune disease get tattoos and don’t experience any serious or long-lasting effects. Consulting a specialist, such as a dermatologist, and a knowledgeable tattoo artist, may help in deciding when and where to get a tattoo. 

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lynn C, Michaela, Herdrich D, et al. The evolutionary adaptation of body art: Tattoo as an honest signal of enhanced immune response in American Samoa. Amer J Hum Biol. 2019:e23347. doi:10.1002/ajhb.23347

  2. Wilson WT, O’Boyle M, Leach WJ. Unusual complication of a tattoo in an immunosuppressed patient. Case Reports 2018; 2018:bcr-2018-224968. doi:10.1136/bcr-2018-224968

  3. Oanţă A, Irimie M. Tinea on a tattoo. Acta Dermatovenerol Croat. 2016;24(3):223-4.

  4. Tohme RA, Holmberg SD. Transmission of hepatitis C virus infection through tattooing and piercing: a critical review. Clin Infect Dis. 2012;54:1167–1178. doi:10.1093/cid/cir991

  5. Centers for Disease Control and Prevention. HIV transmission. Updated August 6, 2019.

  6. Warshaw EM, Schlarbaum JP, Taylor JS, et al. Allergic reactions to tattoos: Retrospective analysis of North American Contact Dermatitis Group data, 2001-2016. J Am Acad Dermatol. 2019;2:e61-e62. doi:10.1016/j.jaad.2019.09.077 

  7. Kirby W, Alston DB, Chen AH. The incidence of hypertrophic scarring and keloid formation following laser tattoo removal with a quality-switched Nd:YAG laserJ Clin Aesthet Dermatol. 2016;9(5):43–47.

  8. Islam PS, Chang C, Selmi C, et al. Medical complications of tattoos: A comprehensive review. Clin Rev Allergy Immunol. 2016;50(2):273-86. doi:10.1007/s12016-016-8532-0

  9. Valbuena MC, Franco VE, Sánchez L, Jiménez HD. Sarcoidal granulomatous reaction due to tattoos: report of two casesAn Bras Dermatol. 2017;92(5 Suppl 1):138–141. doi:10.1590/abd1806-4841.20175860

  10. Orzan OA, Popa LG, Vexler ES, Olaru I, Voiculescu VM, Bumbăcea RS. Tattoo-induced psoriasisJ Med Life. 2014;7 Spec No. 2(Spec Iss 2):65–68.

  11. Ross JR, Matava MJ. Tattoo-induced skin "burn" during magnetic resonance imaging in a professional football player: a case reportSports Health. 2011;3(5):431–434. doi:10.1177/1941738111411698

  12. Kaur RR, Kirby W, Maibach H. Cutaneous allergic reactions to tattoo inkJ Cosmet Dermatol. 2009;8:295-300. doi:10.1111/j.1473-2165.2009.00469.x 

  13. Brady BG, Gold H, Leger EA, Leger MC. Self-reported adverse tattoo reactions: a New York City Central Park study. Contact Dermatitis. 2015 Aug;73:91-99. doi:10.1111/cod.12425

  14. Forbat E, Al-Niaimi F. Patterns of reactions to red pigment tattoo and treatment methodsDermatol Ther (Heidelb). 2016;6(1):13–23. doi:10.1007/s13555-016-0104-y

  15. Rosenbaum BE, Milam EC, Seo L, Leger MC. Skin care in the tattoo parlor: A survey of tattoo artists in New York City. Dermatology. 2016;232:484-489. doi:10.1159/000446345

Additional Reading