Tattoos Associated With Low Complication Rate in Patients With Psoriasis

The highest rate of tattoo-related complications is for patients with psoriasis requiring treatment at the time of tattooing.

The rate of tattoo-related complications in patients with psoriasis is low, according to study results published in the Journal of the European Academy of Dermatology and Venereology. The risk for complications was highest in patients with psoriasis requiring treatment at the time of tattooing, and all complications observed were benign.

The cross-sectional observational study was conducted in 23 centers located within hospitals or private clinics in France. Participating dermatologists were asked to include consecutive adult patients with psoriasis seen between April and August 2018.  Data were collected using questionnaires completed by the dermatologists.

Of the 2053 patients with psoriasis included in the study, 414 (20.2%) were tattooed and 1639 (79.8%) were non-tattooed. Plaque psoriasis was the most common type of psoriasis noted in tattooed patients (72.5%) and 79 patients (19.1%) had associated psoriatic arthritis. Before study inclusion, the most common treatments were methotrexate and phototherapy, followed by adalimumab and ustekinumab. Complications were evaluated on a per-tattoo basis; the cohort had a total of 894 tattoos. Local complications were reported in 58 tattoos (6.5%) as follows: Koebner phenomenon (3.0%), isolated pruritus (2.7%), edema (2.1%), local infection (0.7%), and allergy (0.2%). A psoriasis flare caused by a tattoo was seen in 3.2% of patients. Complications occurred most frequently in patients requiring treatment at the time of tattooing (P <.0001).

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In the non-tattooed cohort, 252 patients (15.4%) reported a desire to be tattooed. In this subgroup, 111 patients (44.0%) did not have a tattoo because of their psoriasis or because of negative advice received from their physician. Of the non-tattooed patients, 93 (5.7%) indicated that they planned to get a tattoo in the future.

Study limitations included memory bias, reliance on retrospective diagnoses, and a lack of data on the duration and severity of complications.

“Dermatologists and healthcare professionals should be mindful of the fact that tattooing is a way for psoriasis patients to express themselves,” investigators wrote. “Our study provides valuable objective information about the risks associated with tattooing in this population. This information should be used by dermatologists and general practitioners to help patients decide if they want to be tattooed or not,” they concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Grodner C, Beauchet A, Fougerousse AC, et al. Tattoo complications in treated and non-treated psoriatic patients [published online September 30, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15975