Think Before You Ink: Tattoos and Adverse Skin Reactions (2025)

One-third of Americans have at least one tattoo. But some may suffer for their body art.

Studies reveal that as many as 10% of people who get tattoos experience painful or itchy skin reactions, and about 6% of people have experienced a chronic reaction that lasts longer than four months. Additionally, you can develop an allergy to your tattoo as you age and experience adverse effects years after getting your tattoo.

Reactions to tattoos can be caused by a variety of factors, including:

• Unsanitary tools
• Pre-existing skin conditions
• True allergy
• Allergic skin reaction

True allergies involve the immune system, while allergic skin reactions usually only involve the skin that has encountered an allergen.

“Overall, most data suggest that around 1 in 1,000 individuals might have a true allergy to a component of their tattoos,” says Jamie Schlarbaum, MD, a dermatologist at University of Utah Health.

Allergic skin reactions are more common, though. That could be because the Food and Drug Administration (FDA) does not regulate tattoo pigments. Many of these pigments contain metals or other additives that may trigger skin reactions. Red ink, which frequently contains mercury sulfide, is one of the most common culprits behind tattoo-related allergic reactions.

Additionally, the body may develop a delayed hypersensitivity to tattoo pigments over time, leading to new reactions years after the initial tattooing process.

“I've seen quite a few of these reactions,” says Douglas Powell, MD, a dermatologist at University of Utah Health. “You can get a spectrum of reactions, from swelling at the injection site to a reaction that can spread diffusely over the body.”

Common skin reactions include:

• Localized inflammation: Temporary redness, swelling, and tenderness after tattooing.
• Allergic contact dermatitis: Persistent itching, redness, and peeling in the tattooed area.
• Granulomas: Small, raised bumps forming around tattoo pigment as a response to foreign particles.
• Photosensitivity reactions: Certain tattoo inks, particularly yellow and red, may cause irritation when exposed to sunlight.
• Pseudolymphomatous reactions: An immune system response leading to firm, swollen nodules.
• Keloid formation: Excessive scar tissue development, particularly in individuals predisposed to keloids.

“A tattoo should be flat, flush with the skin, and not itchy," explains Powell. “If a tattooed area becomes raised, inflamed, or starts itching persistently, it may indicate an allergic reaction that requires medical attention.”

Treatment depends on the severity of the reaction. Options include:

• Topical corticosteroids: Help reduce itching and inflammation.
• Oral antihistamines: Used to manage allergic symptoms.
• Steroid injections: May be necessary for persistent swelling or granulomas.
• Immunosuppressive therapy: For severe or chronic inflammatory responses.
• Laser or surgical removal: In extreme cases where the reaction is ongoing and other treatments fail.

It’s important to avoid using over-the-counter creams that contain potential irritants. Consulting a dermatologist is the best way to determine appropriate treatment.

Before getting a tattoo, consider the following precautions:

1. Check ink ingredients. Ask about the pigments and avoid those with known allergens.
2. Do a patch test. Apply a small amount of ink to test for sensitivity.
3. Choose an experienced tattoo artist. Ensure they use high-quality, well-tested inks.
4. Use gentle aftercare products. Avoid alcohol-based cleansers and scented lotions.
5. Protect the tattoo from sun exposure. Use sunscreen to prevent irritation and fading.

Seek medical care if you experience:

• Worsening redness or swelling that doesn’t improve with time.
• Discharge, crusting, or pus, which may indicate an infection.
• Ongoing pain, itching, or discomfort lasting more than a few weeks.
• A spreading rash or systemic symptoms such as fever or swollen lymph nodes.

Additionally, tattoo removal through laser treatment can sometimes trigger allergic reactions, as breaking down ink particles may cause the immune system to respond aggressively. If considering tattoo removal, consult a dermatologist beforehand.

By taking these steps and understanding potential risks, individuals can make informed decisions about tattoos while prioritizing skin health.