Health Library Tattoo ProblemsFrom Healthwise

Tattoos and permanent makeup have been used by most cultures for centuries and recently have become very popular with both men and women. Most people who have a tattoo do not develop any problems. Home treatment can help speed healing and prevent problems.

A tattoo is a series of puncture wounds that carry dye into the different levels of the skin. At first, the tattoo may be swollen and there may be some crusting on the surface. It is normal for the tattoo to ooze small amounts of blood for up to 24 hours, and it may ooze clear, yellow, or blood-tinged fluid for several days.

Problems with tattoos include:

• Infection at the tattoo site.
• Minor skin reactions (contact dermatitis) or serious allergic reactions to the tattooing method or dye.
• Scarring, which can include raised scar tissue (keloids).
• Spread of infectious disease, such as hepatitis B, hepatitis C, tuberculosis, tetanus, or HIV, if a dirty method or equipment is used.

It is important to consider all aspects of getting a tattoo. A tattoo should be considered permanent. Tattoo removal is difficult and may cause scarring. It may not be possible to completely remove a tattoo and restore your normal skin color and texture. If you have not yet made a decision about tattooing, see the Prevention section for information about tattooing.

Temporary tattoos, such as henna tattoos (mehndi), may also cause problems. Although most of the ingredients in temporary tattoos are safe for application to the skin, there have been reports of allergic skin reactions (contact dermatitis) to the ingredients in some of the tattoos. Henna tattoos are not approved for use by the U.S. Food and Drug Administration (FDA). Henna is a plant-based dye and is approved for use only as a hair dye.

Consumers and health professionals are encouraged to report adverse reactions to tattoos and permanent makeup, as well as reactions to temporary tattoos.

Review the Emergencies and Check Your Symptoms sections to determine if and when to see a health professional.

• Rapid swelling of the tongue or throat causing difficulty swallowing
• Severe allergic reaction (anaphylaxis)
• Moderate to severe difficulty breathing

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

	Yes	Do you have any signs of an allergic reaction after getting a new tattoo?
When to See a Doctor See significance of an allergic reaction if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have hives that came on suddenly and cover all or most of your body? Yes Do you have a feeling of swelling in the mouth or throat without difficulty breathing? Yes Are you having mild wheezing or mild difficulty breathing? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have hives over all or most of your body that came on over several hours after your tattooing? Yes Do you have normal breathing at rest but mild shortness of breath or mild wheezing with any amount of effort? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had hives for 24 hours or longer but you do not have other symptoms? Yes have you had swelling and itching of the tattoo (local allergic reaction) for 24 hours or longer? Yes Have you had a long-term (chronic) mild breathing problem that has slowly gotten worse during the past 24 hours? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have swelling at the site of the tattoo?
When to See a Doctor See significance of swelling if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Is swelling so severe that it cuts off blood flow below the site of the tattoo, making the area cool, clammy, or painful? Yes Do you have severe, rapid joint swelling near the site of the tattoo? Call your health professional today if you answer "Yes" to the following question. Yes Has gradual swelling developed over a joint area after getting a tattoo? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Has swelling that is not in a joint area gotten worse after 24 hours of home treatment? Yes Do you continue to have moderate swelling after 48 hours of home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think you have an infection after getting a tattoo?
When to See a Doctor See significance of infection after getting a tattoo if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease or take medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased pain, swelling, redness, heat, or tenderness around the tattoo? Yes Do you have red streaks extending from the tattoo? Yes Do you have pus coming from the tattoo? Yes Do you have swollen or tender glands (lymph nodes) above or below the tattoo? Yes Do you have a fever or think you have a fever? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had increased pain, swelling, and redness less than 1 in. (2.5 cm) around the tattoo for 24 hours or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you know or think you need a tetanus shot?
When to See a Doctor See significance of getting a tetanus shot if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need a tetanus shot, call your doctor to arrange for the shot as soon as possible. Your need for a tetanus shot depends on the seriousness of your wound and your tetanus shot history. Your doctor may be able to tell you over the telephone if you need a tetanus shot. Call your health professional today if you answer "Yes" to any of the following questions. Yes Are you worried that the tattoo has gotten dirty or has germs on it and your last tetanus shot was longer than 5 years ago? Note: Something is dirty if it has dirt, soil, spit, or feces on it. Yes Are you not sure when you had your last tetanus shot? Yes Did you not get the first series of tetanus shots (primary vaccination series)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had symptoms of another illness in the weeks to months since getting a tattoo?
When to See a Doctor See significance of symptoms of another illness after a tattoo if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you had a general feeling of tiredness, or lack of energy (fatigue)? Yes Have you had a general feeling of illness (malaise)? Yes Have you had a fever of think you have a fever? Yes Have you had loss of appetite? Yes Have you had nausea or vomiting? Yes Have you had constant discomfort in the upper right side of your belly? Yes Have you had dark urine (the color of root beer)? Yes Have you had steady muscle aches or joint pain? Yes Has the skin or white part of your eye turned yellow (jaundice)? Yes Do you have a new skin rash? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a tattoo that is not healing?
When to See a Doctor See significance of a tattoo that is not healing if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you have a tattoo that has not healed after 1 to 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Most minor swelling and redness (inflammation) from a tattoo can be treated at home. If your tattoo artist gave you instructions, follow them carefully.

If you did not receive instructions for skin care of the tattoo site, try the following:

• Stop any bleeding. Minimal bleeding can be stopped by applying direct pressure to the wound. It is normal for the tattoo site to ooze small amounts of blood for up to 24 hours and clear, yellow, or blood-tinged fluid for several days.
• Apply a cold pack to help reduce the swelling, bruising, or itching. Never apply ice directly to the skin. This can cause tissue damage. Put a layer of fabric between the cold pack and the skin.
• Take an antihistamine, such as Benadryl or Chlor-Trimeton, to help treat hives and relieve itching. Be sure to read and follow any warning on the label. Do not use strong soaps, detergents, and other chemicals, which can make itching worse.
• Protect your tattoo with a bandage if it might become dirty or irritated.
  • Apply an antibiotic ointment, such as Polysporin or Bacitracin, to a nonstick bandage, such as Telfa.
  • Apply the nonstick bandage with the ointment on it to the tattoo site. The ointment will prevent the irritated skin from sticking to the bandage. Putting the ointment on the bandage first will be less painful. If a skin rash or itching under the bandage starts, wash the ointment off and don't use that type of ointment again. The rash may indicate an allergic reaction.
  • Apply a clean bandage once a day and change the bandage if it gets wet. If the bandage does stick, soak the tattoo area in warm water for a few minutes or take the bandage off under running water in the shower.
  • Leave the bandage off with the skin open to air whenever you can.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment.

• Signs of an infection develop.
• An allergic reaction develops.
• Your symptoms are not improving after 1 to 2 weeks of home treatment.
• Your symptoms become more severe or frequent.

You can prevent problems from developing at your tattoo site. Review the following guidelines and information before making your decision to tattoo a part of your body.

• Consider the social or emotional risk of having a tattoo. Many people make negative value judgments about people with tattoos.
• Talk with people in different age groups about their tattoos. Some people change their minds after getting a tattoo. Since a tattoo is hard to remove, it is important that your decision to get a tattoo is one you can live with.
• Think about the reasons you want to get a tattoo.
• Do not get a tattoo while under the influence of alcohol or drugs. Since a tattoo is hard to remove, it is important that your decision is made with a clear mind.
• Get a tetanus shot before your tattooing if you have not had one in the past 10 years.
• Choose an experienced person who uses sterile gloves and sterilized equipment to do the tattoo. Ask the person doing the tattoo how he or she cleans the equipment and what safety standards he or she follows. Sterile gloves and sterilized equipment should be used. A fresh pair of gloves should be used for each procedure. Make sure that the operator washes his or her hands before putting on the gloves. Ask the operator to change his or her gloves if he or she answers the telephone or does anything else during your procedure.
• Check the studio and see whether it looks clean. Ask the operator about sterilizing techniques and safety standards.
• If you think you may want to have your tattoo removed at a later date—dark blue, black, and red are the easiest colors to remove with lasers. Bright colors—blue, green, and yellow—are difficult, if not impossible, to remove.
• If you have had an allergic reaction to tattoo dye in the past, do not get any more tattoos. Be sure your health professionals know about these allergies.
  • Wear medical alert jewelry such as a MedicAlert tag if you have had an allergic reaction after a tattoo.
  • If you have had an allergic reaction to the henna used in a temporary tattoo, you have a higher chance of developing a skin reaction to hair dye. Mix up a small amount of the dye solution and paint it on a small patch of skin, such as the inside of your wrist, to see if you are going to have a reaction to it. Do not use the hair dye if your skin turns red or itches.
• Check with your city or county health department to find out whether there have been any complaints about the studio you are thinking of using.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• Who did the tattoo? Where is the tattoo artist located?
• When did you have the tattoo?
• Where on your body is the tattoo? Have you had previous tattoos?
• Were sterile instruments used?
• What home treatment measures have you used to clean or treat your tattoo? Be sure to include any nonprescription ointments or creams you have applied to the tattoo.
• What prescription and nonprescription medicines do you take?
• When was your last tetanus shot?
• Do you have any health risks?

• Allergic Reaction
• Hepatitis B
• Hepatitis C
• Human Immunodeficiency Virus (HIV) Infection
• Puncture Wounds
• Syphilis
• Tuberculosis (TB)

Author:	Sydney Youngerman-Cole, RN, BSN, RNC	Last Updated: October 18, 2006
Medical Review:	William M. Green, MD - Emergency Medicine Alexander H. Murray, MD, FRCPC - Dermatology
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