Although tattooing is an ancient practice, tattoos have become widely available and increasingly popular over the past decade. In fact, about 24 percent of Americans have at least one tattoo. Some members of MySpondylitisTeam have wondered whether tattoos are safe for individuals with ankylosing spondylitis — also known as radiographic axial spondyloarthritis (radiographic axSpA).

“Does anyone know if it’s safe to get a tattoo with spondylitis?” one member asked.

In general, getting a tattoo poses only minimal risks. Still, if you’re living with axSpA, it’s important to take into account some considerations before getting inked.

Common Complications of Tattoos

Tattooing is the process of depositing permanent pigment or ink particles into the skin. During tattooing, the skin’s dermal layer gets punctured up to 0.2 inches (5 millimeters) deep as many as 50 to 3,000 times per minute.

Although tattoos are generally considered safe, they’re not without risk. Researchers have found that common complications range from acute infections to severe illnesses.

There’s no reason to believe that people with ankylosing spondylitis have more complications with tattoos than others. However, there are some complications to be aware of before deciding to get one.

If you do get a tattoo, make sure it’s done by a licensed, experienced professional in a reputable location who uses sterile equipment. According to one study of 90 licensed tattoo artists in New York City, only 56 percent had received training on tattoo-related skin conditions. Additionally, there’s currently no common legislation regarding tattoos in the United States and the European Union. Because of this, complications can and do occur.

Short-Term Complications

It’s common for people to experience discomfort, redness, bleeding, and inflammation of their skin during and after the tattooing process. Some people with preexisting skin conditions may also experience worsening symptoms.

The level of your pain depends on your pain tolerance, as well as the location and size of the tattoo. One MySpondylitisMember reported, “The funny thing is that the little twinges of pain getting my tattoo were nothing compared to my back pain.”

Short-term complications typically improve in a few weeks and may include:

• Allergic reactions — Some people may develop an allergy or hypersensitivity to the tattoo ink, causing an itchy, red, bumpy rash.
• Skin infections — The damaged skin can become infected as it heals, causing inflammatory skin reactions like redness, swelling, and pus.

Importantly, even if you get a tattoo at a reputable facility, it’s possible for certain bacteria that live on the skin’s surface to get under the skin during the tattooing process. Scratching during healing can also lead to bacteria getting under the skin, which can cause an infection and inflammation. In addition, if you are on a biologic to treat ankylosing spondylitis, you may be more susceptible to infections.

Long-Term Complications

If the tattooing equipment isn’t clean and sterile or you’re prone to scarring, you may have a greater risk of long-term complications. About 7 percent of people experience long-term complications after getting tattoos, according to a study published in the Journal of Applied Physiology.

Complications could include:

• Granulomas — An area of inflammation can form immediately around fresh inking or may appear years later.
• Keloids — Raised scars can develop where the skin is broken (in this case, the tattooed area) and overproduces scar tissue.
• Blood-borne diseases — Specific risks are for pyogenic infections with staphylococci, streptococci, pseudomonas, and E. coli and the transfer of hepatitis B, hepatitis C, and HIV.
• MRI complications — Iron in some inks can interfere with MRI image quality and cause inflammation or burning during these exams.

Despite the risks and complications associated with getting tattoos, many MySpondylitisTeam members shared having few to no symptoms after getting one. Some members have undergone additional disease testing from health care providers because of their tattoos. “My new rheumatologist wants to test me for hepatitis just because I have tattoos,” one member shared.

Other Potential Complications With Spondylitis

Ankylosing spondylitis is an autoimmune condition, so it’s commonly treated with immunosuppressive medications — drugs that calm the immune system — such as biologics or steroids. If you’re taking these types of drugs, you may be at higher risk of developing an infection.

If you take any medications via injection, you may want to avoid getting a tattoo on any of your injection sites, such as the arm, abdomen, or thigh. Otherwise, you may need to avoid injecting your medication in that area to give your tattoo time to heal and avoid scarring. “Started methotrexate 4 weeks ago. Missed 1 week so a new tattoo could heal,” one member shared.

Your rheumatologist can help you figure out if your treatment regimen needs to be altered during the process of getting a tattoo. Don’t stop taking your medication unless it is under the guidance of your doctor.

The best way to reduce the risk of complications from getting a tattoo is to seek a professional, licensed studio that uses hygienic practices. It’s also important to understand that everyone is different, and you may need to take special precautions when getting a tattoo. It’s always a good idea to consult with your health care provider and understand your own risks.

Finally, if you experience any adverse side effects or a flare-up of your spondylitis after getting a tattoo, be sure to speak to your doctor right away.

Aftercare of Tattoos

After getting a tattoo, follow aftercare instructions to reduce the risk of complications. Your tattoo artist should also offer guidelines about skin care. However, you shouldn’t go to a tattoo artist for medical advice. At the first sign of an infection, allergic reaction, or other adverse reaction, consult with a health care provider (such as a dermatologist).

It can take a few weeks for a tattoo to heal. No current research suggests that someone with an autoimmune disease might take longer to heal than the general population.

The American Academy of Dermatology suggests following these recommendations after you get a tattoo:

• Cover the tattooed area for 24 hours.
• Keep the skin clean by gently washing the area with soap and water, and patting it dry.
• Apply a thick layer of a mild ointment like petroleum jelly to the tattooed skin several times a day.
• Wear loose-fitting clothing to avoid fabric sticking to the tattoo.
• Avoid sun exposure for at least a few weeks.
• Stay out of pools, hot tubs, rivers, or lakes as the tattoo heals.
• Resist the urge to scratch skin or pick at scabs, which could damage tattoo design, cause scarring, or lead to increased risk of infection.

Tattoos and Self-Esteem

Ankylosing spondylitis can have an impact on your mental health and body image, as well as your physical health. For some people, getting a tattoo helps boost their self-esteem, cope with their disease, and remember that they’re still in control.

Many MySpondylitisTeam members have described feeling empowered by getting tattooed. One member of the community shared their tattoo, which reads “Step into my shoes and walk the life I’m living, and if you get as far as I am, just maybe you will see how strong I really am.”

Another member shared their body art of a flower, butterfly, and child: “I love tattoos. This one represents the birth of my granddaughter.”

Meet Your Team

On MySpondylitisTeam, the social network for people with spondylitis and their loved ones, more than 91,000 members come together to ask questions, give advice, and share their stories with those who understand life with spondylitis.

Have you gotten a tattoo while living with ankylosing spondylitis? Do you have any experiences you’d like to share? Add your thoughts in the comments below, or start a conversation with others on your Activities page.