Tattoos and Lupus: Is There a Risk?

Tattoos are a part of many cultures and en vogue these days. But, what are the potential risks for Lupus Warriors?

Tattoos are a permanent image on the skin formed by injecting and embedding tiny particles of pigment into it. These particles are suspended in the space between the outside of the skin (the epidermis) and the inner layer of the skin (the dermis).

Deriving from the ancient Tahitian practice of Tatu, modern pigments can come in a variety of colors. When done by a qualified tattoo artist, they can commemorate a treasured moment, special person, a culturally significant moment, or be a decoration that makes you happy.

The Role of the Immune System

The body’s immune system is actually a huge part of how tattoos work. White blood cells attempt to ‘eat’ the ink particles and remove them. However, the particles are too big to remove completely. So the white blood cells (also known as macrophages) end up ‘locking’ the ink in place. 

This immune response activates the immune system, and some studies say that it actually exercises the immune system in a good way, helping the body protect itself more effectively. However, inflammation in the body is also the root of many of the complications of tattooing, including:

• Allergic reaction to the tattoo dyes
• Burning or swelling at the tattoo site
• Scaling and other symptoms of skin inflammation 

Tattoo ink can also clog up lymph nodes with ink particles and many can be toxic. The tattoo process itself can also put one at risk for infection at the site (due to the breaking of the skin by the tattoo needle) and blood-borne infection. A reputable tattoo artist who follows proper hygiene protocols can minimize these particular risks. 

Still, any risk of infection – or of inflammation – can be problematic for people with lupus: Not only are they more vulnerable to infection, but inflammation can increase their symptoms or even cause a flare. 

You can read about skin symptoms of lupus, here.

Tattoos, the Immune System, and Lupus

Are tattoos safe for people with lupus. Let’s turn to the research.

A 2019 study on tattoos in people with lupus found no increase in SDI scores or lupus symptoms. (SDI is a measure of lupus disease activity.)

In total, 147 people (142 women 97%) participated in the study. 65 of the 147 (44%) had a tattoo. No participants experienced acute complications. “The median time between the tattoo and the [next] flare-up was 9 (6-14) months.”

Triggering the Immune System

Tattoo’s cause an immune response – typically, this is just some swelling and clouding at the area before it dies down and the tattoo is visible. However, more serious reactions can happen, and usually take the form of:

• Keloids, a form of scar tissue that forms as the skin’s attempt to heal the injury.
• Melanoma, a pigmentation change in the skin that can become dangerous.
• Infection, due to the breaking of the skin and exposure of the injury to pathogens, including hepatitis B and C. This infection can be severe.
• Allergic reactions
  • Especially to cinnabar pigments (mercuric sulfide) used for red and yellow and other ink pigments.

Skin Conditions and Tattoos

Many people with autoimmune diseases have concerns over developing or worsening skin conditions when getting a tattoo. These conditions include:

Allergic Contact Dermatitis

Analysis and research shows that allergic contact dermatitis after a tattoo is quite rare, at a rate of less than 0.08%. This condition occurs most often when using color in tattooing, such as red. It typically presents itself as raised areas within the tattoo. 

Keloids

Keloids are a type of scar that grows when the skin is broken (like when getting a tattoo). The skin repairs itself in an aggressive manner, and usually results in a large scar. It is most common in individuals who have had keloids in the past. Additionally, tattoo removal is also associated with the formation of keloids.

Granulomas and Sarcoidosis

Granulomas are small lumps of tissue that form in response to a perceived irritation. It is believed that these form around the ink used in tattoos. These can appear years after the tattoo is placed. 

Sarcoidosis is when many granulomas grow and is a rare condition. Those already diagnosed with this condition are usually advised against getting tattoos.

Psoriasis

Psoriasis is a chronic skin condition that causes a rash that is red with white scales. Many doctors advise those with psoriasis to not get tattoos, as the trauma to the skin can cause psoriatic lesions. 

Staying Safe while Getting a Tattoo

If you are concerned, discuss getting a tattoo with your healthcare provider. However, a few tips to consider:

• Only get your tattoo when your lupus symptoms are under control. That may minimize any potential risks and damage.
• Make sure that the tattoo artist is a licensed, experienced professional with a good reputation. They will not only give you a better tattoo, they are less likely to cause injury or other issues.
• Do not go to a tattoo parlor if they do not use sterile equipment, regularly sterilize equipment, or do not swab the area with rubbing alcohol or disinfectant. These can increase the risks of infection.
• Take care of the tattoo properly. Gently clean the tattoo site with soap and water, use light moisturizer, and cover a new tattoo with fresh gauze.
• Do not swim or immerse yourself in water for 2 weeks
• Keep tattoos bandaged for 24 hours after it is done, to prevent infection.

If any unusual symptoms come up, check in with a doctor!