Cosmetic Medicine / Plastic Surgery Dermatology

How to tell if a tattoo is infected

The most common side effect associated with tattoos is minor inflammation.

But any time the skin barrier is broken, there is a chance of infection.

In a 2015 poll surveying 2,225 American adults, 29 percent had at least one tattoo. According to 2016 study, between 0.5 to 6 percent of adults who have a tattoo had infectious complications.

Tattoos that cause severe symptoms or pain that lasts for more than a few days or weeks are often infected and require medical attention.

Signs and symptoms

Tattoo artist applying ink to a person's arm using needles
In most cases, tattoos heal with basic care and hygiene. A tattoo artist can provide guidance on caring for a tattoo.

When done by licensed, reputable tattoo artists in a salon setting, new tattoos usually only cause pain, redness, and swelling. As a tattoo heals, the tattoo site often becomes itchy and dry.

With basic care and good hygiene, most new tattoos completely heal within a few weeks.

In some cases, however, tattoos can cause infections that require medical attention and treatment. This is particularly the case in people who have weakened immune systems or allergies to inks, pigments, and dyes.

Symptoms of tattoo infection include:

  • fever, especially over 102°F
  • prolonged or severe pain, redness, and swelling
  • sores that contain or release thick, white or yellow fluid
  • muscle aches and pain affecting the whole body
  • extreme or unquenchable thirst
  • hard, red, raised bumps or wounds
  • diarrhea
  • nausea and vomiting

Another problem that can occur is impetigo, an infection that mostly impacts young children. Impetigo causes sores on the nose, mouth, hands, and feet that develop into yellowish, shiny scabs.


Causes

Most tattoo infections occur because the skin’s barrier has been broken, allowing germs inside.

Tattooing can also cause infection by introducing some infectious substance or allergen to the skin or blood.

Known causes of tattoo infection include:

Bacterial infections

Bacteria in agar jelly in petri dish in research lab.
Contaminated tattooing equipment and ink can cause bacterial infections, including staph bacteria infections.

Some bacterial infections can be transmitted through contaminated equipment, contaminated ink, and the entry of bacteria into the wound site.

Bacterial infections associated with tattoo infection include:

Staphylococcus aureus and Methicillin-resistant staphylococcus aureus (MRSA) infections

Staphylococcal bacteria are a common cause of skin infection and one of the more common reasons for tattoo-related infections.

While many species of staph bacteria are treatable with basic antibiotics, a variety of S. aureus known as MRSA has become resistant to most known antibiotics and is extremely difficult to treat.

People with MRSA often experience severe fever, body pain, pneumonia, and immune-related conditions, such as arthritis, a week or two after exposure.

Additional complications associated with MRSA infections include:

  • bloodstream infections and sepsis
  • toxic shock syndrome
  • red, blistering patches
  • organ failure
  • infection and swelling of the tissues that line the heart valves
  • coma
  • death

Nontuberculous mycobacteria (NTM) infections

In the last decade, NTM infections have become an increasingly common cause of tattoo-associated skin infections.

Most NTM infections appear to be caused by contaminated ink and the use of unsterilized water during the dilution of inks in parlors.

According to a report from the Centers for Disease Control and Prevention (CDC), one brand of ink contaminated with Mycobacterium chelonae caused 35 infections in 19 states.

Symptoms of NTM infections most commonly include red or transparent patches of raised, thickened skin that may come and go over a period of weeks to months.

Viral infections

Several types of viral infections can be passed on from a contaminated, contagious source when the skin is broken. The source of viral infections is often needles or equipment that has not been properly cleaned between uses.

Potential viral infections associated with tattoos include:

Ink toxicity, contamination, or allergy

According to a 2016 study, contamination rates above 10 percent are not uncommon for tattoo inks. Some people, especially those with immune conditions, have more severe immune responses to the procedure and inks used.

Some people are also actually allergic to the tattoo ink itself; usually, specific molecules called haptens, which are most prevalent in red, blue, and green inks.

Tattoo ink allergy responses are often quite severe, causing extremely itchy, hard, thickened, blistering wounds that require medical attention.

Treatment

Most professionally performed tattoos only cause minor inflammation. Rest, ice, and elevation tend to help relieve most of the side effects of new tattoos.

Over-the-counter anti-inflammatory medications, such as Tylenol, may also help make the first 8 to 24 hours after getting a tattoo more comfortable.

Antihistamine medications, such as Benadryl, can reduce the symptoms of minor allergic reactions, such as small, red bumps or a faint rash around the tattoo site.

Antibiotic creams, ointments, or pills are the first recommended line of treatment for most minor skin infections.

If more serious conditions are suspected — such as viral or blood infections — a small skin sample may be collected from the affected area for laboratory examination and diagnosis.

Most treatments options that require more than routine antibiotics are determined by the specific cause of each case.


Prevention

Tattoo artist speaking with customer in parlor studio.
Choosing an established and reputable tattoo artist or parlor is the easiest way to minimize the risk of infection.

The easiest way to prevent or reduce the risk of a tattoo infection is to choose a licensed, reputable, tattoo artist and salon.

People with weakened immune systems and those with contagious blood or skin infections should usually refrain from getting tattoos to avoid further complications and the risk of infecting others.

Other considerations that can help reduce the risk of tattoo infections include:

  • Choosing technicians and salons that have been in business for at least a few years and have a reasonable amount of reviews for their area or years of experience.
  • Assessing the cleanliness of the salon before committing to the procedure. A dirty lobby is often a sign of an overall unhygienic setting.
  • Ensuring that the technician uses new needles and sterilized equipment. If unsure, ask.
  • Ensuring that the technician uses single-use ink containers and FDA-approved ink, or ask if they are.
  • Ensuring that the technician uses a sterile swab, rinse, or antiseptic wash to clean the skin area being tattooed before starting.
  • Ensuring that the technician is wearing sterile gloves throughout the entire procedure.
  • Never getting a tattoo at a place or from a person that feels or seems uncomfortable, stressful, or questionable.
  • Telling technicians about sensitive skin ahead of time so that they can plan ways to reduce overall irritation. This can involve completing tattoos over several sessions.

People who have known allergies or are very sensitive to inks should be sure to talk with the technician ahead of time about the products they use.

After getting a tattoo, the risk of infection can be significantly reduced with basic at home care, especially keeping the tattoo site clean.

Additional tips for preventing tattoo infections at home include:

  • cleaning the area with soap using clean, washed hands
  • applying over-the-counter antibiotic ointments or creams to the tattoo site once or twice daily
  • covering the tattoo site with fresh, sterilized gauze or bandages
  • using moisturizers to help reduce the risk of scarring and itchiness
  • wearing socks or gloves on the hands while sleeping or relaxing to avoid scratching new tattoos

Other tattoo-related complications

Researchers have only been actively monitoring tattoo-associated risks for the past few decades. As tattoos become increasingly popular, more studies are being done to identify potential complications and how to prevent them.

Additional documented tattoo complications include:

  • scarring
  • infection occurring years after healing
  • long-term inflammation associated with tattooing
  • sensitivity to light
  • neurosensitivity and pain
  • pigment spreading to other areas of skin
  • lymph node disease
  • keratoacanthoma, a minor tumor classified as a non-melanoma squamous cell carcinoma

Tattoos are not considered to be a risk factor for cancer.


Outlook

Any time that the skin barrier is weakened, or the body is directly exposed to foreign materials, an infection can occur. Most new tattoos heal and stop causing unpleasant symptoms within a few weeks.

Although most infected tattoos heal with antibiotic ointments or oral pills, skin and blood infections can cause life-threatening complications.

A medical professional should assess symptoms that do not improve within a few weeks of basic care as well as severe, tattoo-related symptoms of any kind.

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