Why Tattoos May Trigger Psoriasis
One of the more common, but least understood, psoriasis triggers is an injury to the skin. This includes cuts, scrapes, burns, sunburns, insect bites, and puncture wounds. Even irritation caused by a tight belt or a shoulder strap may trigger a flare.
According to a 2013 review in the Canadian Medical Association Journal, around 25% of people with psoriasis will experience a flare as a result of skin trauma.
This effect is commonly known as the Koebner phenomenon (or simply the Koebner response). It is defined as the appearance of skin lesions along the site of a trauma.
Despite knowing about the Koebner phenomenon for more than a century, scientists remain uncertain as to why it occurs. At its heart, the Koebner response describes the body’s overreaction to an injury.
Immune Response to Skin Injury
One theory suggests that the phenomenon occurs when the outer and middle layers of the skin (known, respectively, as the epidermis and dermis) are simultaneously injured. When this occurs, the immune system sends defensive cells (such as T-cells and cytokines) to the site of the injury to aid in the repair. By doing so, the resulting inflammatory response may inadvertently trigger disease activity in those tissues.
The hypothesis is evidenced, in part, by psoriasis flares in people who have undergone radiation therapy and have deep bruising. Although the epidermis may remain uncompromised, the underlying dermis will have sustained enough injury to incite an autoimmune response.
Based on what is known about psoriasis and the Koebner phenomenon, it makes sense, then, that tattoos can incite an autoimmune assault. Tattoo needles puncture both the dermis and epidermis when ink is being injected into your skin, which can trigger the same response as any other skin injury.
Older Tattoos and Flares
Interestingly, the period between a skin injury and the presentation of psoriasis can range from three days to two years, according to a 2011 study in Clinical Dermatology. There are even cases where tattoos completed decades earlier will suddenly be the primary (and sometimes initial) site of a psoriatic flare. On one day, a tattoo may appear perfectly normal, and, the next, the tissues may begin to swell and flake, spreading outward to adjacent skin.
What this suggests is that skin trauma is probably not the sole trigger of psoriasis, or even a major one. Instead, other factors may instigate the onset of symptoms, while scar tissue may simply serve as a convenient target.
This may be due to the fact that skin cells called keratinocytes behave differently in scar tissue. Rather than undergoing the normal 40- to 56-day life cycle where old cells are replaced with new cells, keratinocytes in scar tissue persist and proliferate, causing the thickening of tissues known as epidermal hyperplasia. The rich population of keratinocyte receptors may serve as the obvious target should psoriatic disease develop; it’s the acceleration of this cell growth that leads to the formation of psoriasis plaques.
Considerations
As concerning as the risk of psoriasis flares may be, it is important to note that tattoos don’t always cause problems in people with the condition. Statistically speaking, there is a one-in-four chance of a Koebner response following a skin trauma, including a tattoo.
With that being said, the risk may be significantly higher if you’ve ever experienced a flare following a cut, burn, or sunburn, or develop psoriasis seasonally due to cold, dry weather.
In addition, tattoo dyes (particularly yellow and red dyes) may cause skin allergies that incite an autoimmune response. If you are prone to skin allergies, consider getting a patch test beforehand to see how your skin reacts to the ink.
If you experience a flare after getting a tattoo, see a dermatologist. Depending on the severity of symptoms, you may be prescribed a topical steroid or other treatments to relieve pain and inflammation.
Before You Get a Tattoo
Some facilities will not serve individuals who have an inflammatory skin condition like psoriasis, regardless of whether the disease is active or not. Furthermore, some state laws prohibit parlors from tattooing people with skin conditions. Make sure you ask ahead of time.
It is also a good idea to check the state laws regarding tattoo sanitation, including the use of protective gear, disposable needles, and sterilization equipment. Most states require some form of licensing which you should check in advance of your appointment.
A Word From Verywell
Perhaps most importantly, speak with your dermatologist before getting a tattoo to fully weigh the pros and cons based on your medical history and personal risk factors. If you decide to get a tattoo, consider having it done in stages. If possible, start with a small tattoo you can live with, and schedule additional procedures every three to six months if your skin remains clear.
