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Only about 8% of people with psoriasis sought medical advice before getting a tattoo, recent survey findings showed. The results led researchers to call for more education around the risks, including infection and skin lesions, that can be associated with tattooing in this population.

The paper appeared in .

Psoriasis is not considered a strict contraindication for tattooing, although it is generally not advised for people undergoing systemic immunosuppressive therapy during active disease.

Researchers circulated a questionnaire among online communities dedicated to psoriasis, and ultimately analyzed 150 tattooed patients with psoriasis.

Eight percent of respondents sought medical advice before getting a tattoo. While undergoing the tattooing procedure, 23 (15.3%) respondents received systemic psoriasis treatment: 9 (6%) with biologics, 8 (5.3%) were treated with methotrexate, 5 (3.3%) with cyclosporine A, and 1 (0.7%) with acitretin. Thirteen (8.7%) respondents experienced complications associated with their tattoos. The Koebner phenomenon, in which lesions appear on the tattooed area, was most frequent, with 8 (5.3%) cases.

One hundred thirty (86.7%) participants reported being tattooed in a professional tattoo parlor; 20 (13.3%) reported receiving their tattoo under amateur conditions.

Additionally, 76 (50.7%) of patients reported higher self-esteem after getting tattooed.

Paper first author Patrycja Rogowska, MD, PhD, is a dermatologist and investigator with the Medical University of Gdańsk in Poland. Here she discusses study findings with the Reading Room. The exchange has been edited for length and clarity.

What key question was this study was designed to address?

Rogowska: A certain percentage of patients with psoriasis either have or plan to get a tattoo. Complications of tattooing in psoriatic patients are usually mild and transient, and tend to appear more frequently in the active stage of the disease or during systemic treatment.

Still, they carry some risks. For example, immunosuppressive treatments increase the risk of infection, especially when tattooing occurs in unhygienic conditions.

As the popularity of tattooing rises worldwide, this is an important topic to explore at this particular time.

Our key objective was to assess the knowledge level of tattooed psoriasis patients about the potential risks of tattooing and to explore their attitudes and tendencies toward this procedure.

How would you summarize the study and its findings?

Rogowska: Knowledge about the safety of tattooing in the psoriasis patient population is low.

Education about the risks associated with tattoos is advisable in this population, as well as in other patient populations with chronic dermatoses.

You found that many people with psoriasis who receive tattoos see improved self-esteem. What do you think explains that finding?

Rogowska: From a psychological perspective, tattooing may have a positive impact on people suffering from psoriasis. In this setting, tattoos provide an opportunity to emphasize independence from the chronic skin disease. The negative stigma associated with psoriasis is "replaced" by a more positive one. Thus, the tattoo can improve a patient's level of acceptance of their disease and increase their self-esteem.

The study concluded that a higher level of education on tattooing in psoriasis is advisable. How can dermatologists help increase that level of education?

Rogowska: It can be provided through social campaigns that promote safe tattooing among patients and tattooists.

Patients interested in getting tattooed should be precisely informed about potential consequences that might occur after the procedure. Finally, dermatological counseling on choosing the best time for tattooing and on the safest anatomic location is recommended for patients with psoriasis who are considering getting a tattoo.

Are there any additional take-away messages from this study for clinicians?

Rogowska: Low attendance at medical offices could result from patients' lack of knowledge about the risks associated with being tattooed, but also from the fear of being judged by the doctor, who may not approve of their decision to get a tattoo.

In certain situations, prophylactic antibiotics can be used to minimize infection risk.

IMPLICATIONS FOR PRACTICE:

• A very small percentage of people with psoriasis sought medical advice before getting a tattoo.
• Infection risk is higher for people undergoing immunosuppressive therapy.
• Counseling on the best time and anatomic location for tattooing is recommended.