Stephanie Waits has three tattoos: the word "hope" on her left wrist; flowers and a Virginia Woolf quote on her left outer thigh, all in black and gray; and a "memorial tattoo" of a mirror with her dad’s initials plus a quote from an Emily Dickinson poem that’s gray and black, with blue flowers, that wraps around the inside of her right bicep.
Waits, 24, has plaque and guttate psoriasis. Like many people with psoriasis, she has chosen to get tattoos despite potential risks of further irritating her skin.
"It is a risk, but I think with the nature of the disease, every day feels like a risk anyway," says Waits, who is in graduate studies at San Diego State University. "If I run into something, if I cut myself shaving, even that can be a risk."
Waits says she researched tattoos and psoriasis before meeting with a tattoo artist, though she found more personal stories than any solid medical advice online. Her dermatologist at the time didn't have any specific advice either, she says.
"I thought about it for a long time, and I think it's worth it to me because I see something that I like on my skin. At least I would have control over what it was, knowing it was my decision."
For Mark Mehrer, having much of his upper body covered with tattoos is about expressing the individual he's become, as well as the journey the 39-year-old has taken to reach this place in his life.
"There's been this growth for me. I have developed a strong sense of spirituality, or purpose, so a lotof the tattoos are emblematic of that," says Mehrer, of Lawrence, Kansas, whose body art includes mostly gray designs that spread up his biceps and across his chest and back.
Several years ago he gave up smoking and drinking. Now he strives to live as stress-free a life as possible. "I've lost friends, so some [tattoos] are in memory of those people. I have a Bible verse on one arm. It all kind of flows together and when things will happen in my life, it'll impact me and I'll go talk with the tattoo artist and come up with a new idea."
Something Mehrer, a corrections officer, hasn't worried too much about as he's added tattoos is how the artwork could affect his psoriasis. While he's had plaque psoriasis since his teens — and early on experienced severe flares — Mehrer says patches now are confined mostly to his legs.
"It's very mild. I have some on my shins and my knee, but my upper body, where all my tattoos are, is relatively psoriasis-free. I'll occasionally have spots on my elbows and, in the winter time, my fingers are cracked....The [tattoos] on my arms have gotten spots, but I just use a lot of ointments and creams."
Some in the medical field aren't as convinced the benefits of having a tattoo are worth the risk. Ask Dr. Kenneth Wasserman, a dermatologist in South Philadelphia, Pa., how wise it is for those with psoriasis to get inked and you'll get an earful.
"One of the issues, any time the skin is traumatized, is psoriasis can occur in that area," says Wasserman, referring to what's known as the Koebner phenomenon. "And tattoos are trauma. In order to get a tattoo, needles have to be put in and there's trauma that happens to the skin. It's likely to bring up psoriasis in those areas."
Like Mehrer, Waits acknowledges she's experienced this with her tattoos, though not with all of them. "I do get flare-ups in the areas where I did get my tattoos — on my leg and my arm I do flare up, but I have one on my wrist and I don't get it there."
Wasserman discourages tattoos for all of his patients, not only those with psoriasis. "I always tell patients, 'If you like the picture, hang it on your wall. Hang it over your desk. You can look at it all day.' But if they say they're going to do it anyway, what am I going to say? I can't stop them."
Dr. Jeff Crowley, a Bakersfield, Calif., dermatologist and clinical researcher, has a different perspective. He says the relationship between tattoos and psoriasis has not been scientifically proven. "In the many hundreds of patients I have treated with psoriasis and tattoos, I have noted no relationship between the tattoo 'trauma' and psoriasis, says Crowley, a member of the National Psoriasis Foundation Medical Board. "Some patients do develop lesions over portions of their tattoos, but this may just be the normal course of their psoriasis.
"The message is to remember that a tattoo is permanent and you should carefully weigh the pros and cons of getting one."
Working with the tattoo artist
Tattoo artists may not necessarily know if a client has psoriasis.
"I did have a few little patches and she was just, 'Oh, you're a little bit rash-y,'" Waits says of her tattoo artist, Briana Sargent of BUJU Tattoo in San Diego. "I told her that it was psoriasis and that I had the disease but it should heal up fine, and we just moved the tattoo so not too much was covering it. She also offered to do touch-ups if any of my spots didn't heal properly, which was awesome and made me feel really at ease and comfortable."
San Diego tattoo artist Briana Sargent is careful where she places body art on Stephanie Waits and other clients who have psoriasis.
Sargent, who has been tattooing for five years, says she's careful about where to place a tattoo on someone with the disease. "If a patient has an area with obvious psoriasis scales and redness, I would not tattoo that area."
Discoloration is one possible outcome of tattoos on psoriasis-prone skin, says Waits, who has extensively researched the issue. For this reason, some artists may be hesitant to do the tattoo.
"They might be a little apprehensive," she says. "It's important to talk with them and also to understand if they are uncomfortable about it, know it's not that they don't want to touch you. It's that they have to stand by their work. They may just be starting out."
Some tattoo establishments may even refuse to give one to someone with psoriasis. In Louisiana, for example, state law prohibits operators from tattooing on individuals "with psoriasis or eczema present in the treatment area."
"Every time I go in and fill out the sheet, one of the questions they ask is, do you have psoriasis?" Mehrer says of his experience with two tattoo artists in Kansas. "Of course I say yes. They won't give a tattoo to an affected area."
It's also good to speak openly with your dermatologist if you're planning to get a tattoo.
Waits said her doctor "knows a lot about the disease." She asked him very specifically about tattoos because of blood-thinning medication she takes. Her doctor told her that wasn't a problem. "He just knows a ton about the treatments and a ton about the disease. He reminded me about the Koebner effect. It just made me feel much more comfortable."
Both Mehrer and Waits agree that knowing your body and what generally triggers your psoriasis is helpful in determining if and where you get a tattoo.
"Start out with something smaller, see how your body adjusts to it," Waits says. "I think they say you need to be prepared to have it not exactly the way you want it, but still be able to have a voice in the matter. It was my choice and my decision so I was comfortable with it not looking perfect — the discoloration can happen. People should still feel very confident in their decision. It's why anyone would get a tattoo — to get something that is meaningful to you."
If you have psoriasis and are thinking about getting a tattoo, talk with your dermatologist about potential risks related to your specific kind of psoriasis and current treatment regimen. Although almost every state has regulations for the proper sanitation of tattoo parlors, you should look for the following to minimize infection risk, according to the American Academy of Dermatology:
- An autoclave. This is a heat sterilization machine that should be used to sterilize all nondisposable equipment after each customer. Instruments and supplies that cannot be sterilized with an autoclave should be disinfected with a commercial disinfectant or bleach solution after each use. These include drawer handles, tables and sinks.
- Fresh equipment. Watch the tattoo artist and make sure he or she removes the needles and tubes from sealed packages before starting work. Any pigments, trays and containers should be sealed before use as well.
- Gloves. The tattoo artist must wash his or her hands and put on a fresh pair of surgical gloves for each procedure. The artist should change those gloves if he or she needs to touch anything else, such as the telephone, during the procedure.
Also, ask if the tattoo artist is licensed and has completed a course in blood-borne pathogens, advises Sargent of BUJU Tattoo..
Check with your doctor before getting a tattoo!
If you’re considering getting a tattoo, you’ll want to talk with your doctor about how your skin could be affected because of certain treatments used to manage your psoriasis.
One consideration: Soriatane, among a class of drugs known as retinoids, has been shown to increase the risk of scarring in patients. It’s possible that getting a tattoo could lead to inflammation, which in turn could lead to some scarring in patients taking Soriatane, says Traverse City, Mich., dermatologist Dr. Ray Dean.
Making sure you’re getting a tattoo in a reputable tattoo parlor always is important, particularly if your medications are suppressing your immune system, Dean says. When using biologic medications, your body is at a higher risk for contracting blood-borne pathogens such as hepatitis B or hepatitis C, he says.
Also keep in mind that topical steroid treatments can thin your skin, and therefore getting a tattoo in these areas of your body could be more problematic. “If your skin gets thin, you’re going to bruise and tear more easily,” Dean says, adding that working with an experienced tattoo artist is important. “A tattoo artist should see enough skin that they should know what healthy skin is. I would imagine they probably want a canvas that’s pretty healthy.”
Talk with your dermatologist before getting a tattoo, Dean says, and consider starting with a small one. “Go with something small to see how you do with it and proceed with caution. You’ve got to feel right about it.”
(From the editor: This story originally ran in the Fall 2011 issue of Psoriasis Advance. We're pleased to update it here with the original photos restored.)
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