Can You Get a Tattoo if You Have Psoriasis?

For some people with psoriasis, getting a tattoo can be an empowering way to feel more in control of their skin. Others don’t want to let their condition stand in the way of the body art they’ve always wanted. Whatever your motivation, if you’ve got psoriasis, you may wonder if it’s OK to go ahead with a tattoo.

The short answer is yes. “Having psoriasis does not preclude someone from getting tattoos,” says Brendan Camp, M.D., a dermatologist with MDCS Dermatology in New York City and Long Island. Still, there are some precautions you’ll want to keep in mind. Here, our experts share what to consider before getting inked if you have psoriasis, plus how to find a reputable tattoo studio and care for your skin while your body art heals.

While psoriasis doesn’t make getting tattoos an automatic no, “it’s important to understand the potential for psoriasis to worsen [from the tattoo],” says Marisa Garshick, M.D., an assistant clinical professor of dermatology at Cornell-New York Presbyterian Medical Center in New York City.

In fact, a survey of 150 psoriasis patients with tattoos found that getting a tattoo could exacerbate symptoms. You also shouldn’t receive a tattoo while you’re in an active flare, since doing so can increase the risk for flares or infections, explains Hyemin Pomerantz, M.D., a dermatologist with Viva Skin Dermatology and Aesthetics in Wellesley, MA. And avoid getting a tattoo directly over an existing psoriasis plaque, since the tattoo could worsen the plaque, she says.

If you have psoriasis, some of the risks of getting a tattoo will be unique to your skin condition. These include:

• Infection

• Koebner phenomenon

• New psoriasis flare

Let’s discuss each one in a bit more detail.

Infection

Unsterilized equipment or improperly caring for a new tattoo poses an infection risk for anyone. But if you’re taking immunosuppressants (like adalimumab or infliximab) for your psoriasis, you could be even more prone, since the medications can make it harder for your body to fight off infection-causing germs, Dr. Pomerantz explains. “If you’re on a medication that lowers your immune system, it’s important to talk with your dermatologist before deciding to get a tattoo,” she says. Your doctor may advise against it while you’re on the medication.

Koebner Phenomenon

The biggest risk tied to getting a tattoo with psoriasis is the Koebner phenomenon or response, which is when new psoriasis plaques develop over injured skin. This type of reaction isn’t limited to tattoos. Any kind of trauma that penetrates the skin’s top and middle layers could potentially trigger it, including piercings, punctures, bug bites, scratching or picking, surgical wounds, burns, and even sunburns.

Around 25% of people with psoriasis develop Koebner phenomenon from skin trauma, reports the survey on tattoos and psoriasis mentioned above. It usually shows up within 10 to 20 days after the skin has been injured. Unfortunately, it’s hard to predict with certainty whether or not the Koebner phenomenon will result from your tattoo. But if you’ve developed plaques caused by the Koebner response after a previous skin injury, there’s a higher chance that a tattoo could cause another one, Dr. Camp says.

New Psoriasis Flare

It’s possible that a tattoo could also cause your psoriasis to flare up elsewhere on your body, instead of over the tattoo itself. This might occur if the stress of getting a tattoo triggers or exacerbates an immune response, which is systemic (meaning the resulting inflammation can occur anywhere on your body, not just at the site of the tattoo). For that reason, “I would suggest trying to make sure any existing flares are under control before getting a tattoo,” recommends Dr. Pomerantz.

There are other, more general risks that would apply to anyone who gets a tattoo, regardless of whether they have psoriasis or not. These include:

• Allergic reactions to tattoo pigment

• Formation of granulomas or inflammatory papules (inflammatory bumps that are benign but can be uncomfortable)

• Infection

• Scar formation

Some of these risks can be mitigated by making sure you get your tattoo at a safe and reputable studio. (More on that below.)

Henna is a type of red or brown ink made by mixing the dried leaves of the henna shrub with oil or water that can be used to create temporary tattoos on the skin. Unlike conventional tattoos, henna doesn’t penetrate or injure the skin.

Traditional red or brown henna tattoos are generally considered safe, according to the Cleveland Clinic. And in fact, certain compounds found in henna ink have been found to activate skin receptors that are thought to be involved in helping psoriasis skin health. “So there’s a theoretical chance that henna ink can improve psoriasis. However, it hasn’t been studied as an actual treatment,” says Dr. Pomerantz.

Not all types of henna are created equal though. Black henna contains additives, such as p-phenylenediamine (PPD), to make it darker and longer-lasting. PPD has been shown to cause serious allergic reactions as well as redness, blisters, weeping, sensitivity to sunlight, and scarring in some people, the FDA says.

For those reasons, black henna should generally be avoided, whether you have skin conditions or not, Dr. Pomerantz notes.

A tattoo is a big decision, especially if you have psoriasis. If you’re thinking about getting one, it’s important to take steps to reduce your risk for complications.

Start by seeing your dermatologist. Together, you can talk about your current symptoms and medications to determine whether now is the right time to get your tattoo, Dr. Pomerantz says. If your psoriasis is in remission, she’ll likely give you the green light, depending on the meds you’re taking. But if you’re flaring or are taking immunosuppressants, you might decide to wait until your psoriasis is better controlled before getting your tattoo. Your dermatologist might also offer options, like a prescription steroid cream, that you can use preventively to reduce the chance for a flare-up, Dr. Garshick says.

Finding a Safe Tattoo Studio

Once you and your derm have decided that now is a good time for a tattoo, you’ll need to do your research to make sure the tattoo studio and artist are safe and reputable. Dr. Camp recommends visiting the tattoo studio ahead of time to become familiar with the space and speaking directly with the tattoo artists. Per the Mayo Clinic, here are some questions to ask:

• Are your tattoo artists licensed? Specifics vary by state, but tattoo studio employees should be properly certified and trained according to local regulations.

• Does the tattoo artist wear gloves? A clean, fresh pair is a must for each tattoo.

• How will my skin be prepped before the tattoo? Prior to tattooing, the artist should clean your skin using an alcohol swab or antiseptic soap, Dr. Pomerantz says.

• Is non-disposable equipment sterilized? Most non-disposable equipment should be heat sterilized using an autoclave. Drawer handles, tables, and sinks should be disinfected with a commercial disinfectant or bleach.

• What equipment is used? The artist should use new needles, tubes, pigments, trays, and containers for your tattoo. The needles and tubes should be in sealed packaging before use.

It typically takes around two weeks for a new tattoo to heal, according to the Mayo Clinic. During that time, your tattoo after-care routine will look pretty similar to what it would be if you didn’t have psoriasis, with a few extra precautions, Dr. Pomerantz says. She and Dr. Garshick recommend that you:

• Apply moisturizer regularly. A layer of rich ointment like Vaseline or Aquaphor can help skin heal and control itching, as well as protect against external irritants that could exacerbate your psoriasis or cause an infection. Apply it several times a day.

• Avoid sun exposure and swimming. The sun can irritate your skin, while swimming in rivers, lakes, pools, or the ocean could expose you to infection-causing bacteria.

• Be mindful of your triggers. If you know there are things that cause your symptoms to flare (like certain foods, alcohol, or stress), be extra careful about steering clear as much as possible.

• Don’t touch it. Avoid picking or scratching at the area, which slows healing and increases infection risk.

• Keep the tattooed area clean. Wash it gently with warm water and mild soap (like Vanicream Gentle Body Wash) and pat it dry carefully. Don’t rub it.

• Watch for signs of infection or flares. If you notice an uptick in pain or redness or signs that you might be developing new plaques, see your dermatologist.

• Wear loose clothing. It will be less likely to stick to your tattoo.

Getting a tattoo when you have psoriasis comes with some risk. But the potential hazards are manageable if you talk with your dermatologist, avoid tattooing during a flare or over an active patch, and are mindful about safety and aftercare.