Think Before You Ink: What to Know About Tattoos and Skin


Tattoos are on the rise, and have even filtered into esthetics, where permanent makeup solutions and microblading have become trendy.

These decorative pieces on the skin can sometimes come at a cost—tattooed skin is at a heightened risk for inflammatory and other reactions, which can cause both immediate and prolonged adverse effects.

Read on for how to help clients think before they ink.

Art at a Price

According to Marie Leger, M.D., “we don’t really know” who is at risk for adverse skin reactions after a tattoo.

"While the purpose of tattooing is decorative, our immune response is also activated; sometimes in unpredictable ways."—Marie Leger, M.D.

Because of this, estheticians should advise clients considering tattoos carefully, especially those with existing skin conditions such as psoriasis and eczema. This goes for esthetic procedures as well, since “microneedling, laser therapy, fillers and [botulinum toxin injections] also have associated risks—some similar and some distinct to that particular procedure,” noted Leger.

Physiology and Reactions

When skin is tattooed, needles make fast punctures into the skin to deposit particles of ink up to two millimeters into the dermal layer. After the tattoo is applied, ink is able to remain in the skin by entering the immune system in cells such as macrophages and fibroblasts—according to Leger, “this allows tattooing to be a ‘permanent’ process.”

“The skin is an important part of our immune system, and while the purpose of tattooing is decorative, our immune response is also activated; sometimes in unpredictable ways,” said Leger.

One such way is the Koebner phenomenon, wherein psoriatic skin develops scaly lesions after an injury—including the initial trauma of a tattoo. This reaction can present up to two years after the tattoo is applied. Lesions are temporary and limited to the area that the skin was damaged, even if it was healthy before the trauma.

" ... side effects are difficult to determine due to the individuality of each person’s biological system."—Society of Permanent Cosmetic Professionals

Sun exposure is also a concerning factor for tattooed skin, since when ink is exposed to the sun it can sometimes “break down into an allergic compound,” according to Leger. Tattoos over moles can mask potential cancerous areas, leading to late cancer diagnoses.

Red has been found to be the most likely pigment to cause adverse reactions in the skin, including:

Other potential complications to tattooed skin include keloid scarring, edema and sarcoidosis, in which black tattoos can become pebbled or raised to indicate the inflammatory condition.

Tattoos Meet Esthetics

As with other esthetic procedures, a detailed client history is crucial before performing microblading or other permanent makeup treatments; contraindications for microblading alone include clients on blood thinning or thyroid medication, those with diabetes and other diseases, those having recently undergone other esthetic procedures and poor hygiene.

According to the Society of Permanent Cosmetic Professionals, “ … side effects are difficult to determine due to the individuality of each person’s biological system. This is why professional permanent cosmetic technicians require a client history profile to be filled out to assess different factors that may contribute to your experience after the tattooing procedure has been completed.”

detailed client history is crucial before performing microblading or other permanent makeup treatments.

In a survey performed of New York City tattoo artists, while 90% of artists had been asked by clients to advise on the safety of tattoos with preexisting conditions – 92.8% had been asked to evaluate adverse reactions after a tattoo—only 56.1% of artists had received training on tattoo-related skin conditions. However, 90% of surveyed artists showed interest in receiving more formal training on tattooing with preesisting conditions.

“Our study and my experience shows that tattoo artists are often asked these questions, and are very interested in learning more about them,” said Leger.

Product lines, such as Evonik’s Tattoo Care concept, exist specifically for the care of tattooed skin. Products in such lines include creams that support the skin barrier and provide luminosity to the pigment in tattoos. Other options include SPF or prepare skin for a tattoo by moisturizing and stimulating epidermis regeneration in order to recover more quickly. Water-based products are the recommended option by the American Academy of Dermatology, as petroleum-based products can cause ink to fade.

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