A tattoo is a creative way to express yourself and show your personality. But if you have hidradenitis suppurativa (HS), you might wonder if getting a tattoo can cause an HS flare-up or affect your skin health in other ways.

For those with hidradenitis suppurativa, tattoos can be a positive experience. In fact, those with HS are more likely than the general population to get permanent body art like tattoos and body piercings. You might want a tattoo to:

• Feel more in control of your body
• Hide or distract from HS lesions
• Cover surgical scars from HS
• Improve your body image

Still, concerns about infections or healing might make you hesitant to get the body art you want while living with HS. As one myHSteam member shared, “I really want some tattoos, but I want to know if there are or can be issues with getting them when you have HS.”

Here’s what you need to know about tattoos and HS.

Is It Safe To Get a Tattoo With HS?

Having a chronic skin disease doesn’t necessarily mean you can’t get a tattoo. However, when you have a skin condition like HS, it’s important to think carefully about the risks. Always talk to a dermatologist before getting a new tattoo or any skin treatment. They can help you understand how your HS might react and whether tattooing is safe for you.

If your dermatologist says it’s OK to get a tattoo and you decide to go ahead, you should never tattoo over active HS lesions. Tattoos are prone to infection, especially without proper aftercare, and it’s never advised to poke or pop HS cysts and lesions.

Which HS Complications Can Happen From a Tattoo?

Tattooing over active HS lesions can lead to skin infections, which can spread into the bloodstream. HS lesions and pitting can cause tunnels under your skin (called sinus tracts). These may act as channels for blood, pus, and infection-causing bacteria, increasing the risk of complications.

When a tattoo parlor follows strict hygiene practices, infections and blood-transmitted diseases from tattooing are rare. In a study published in Dermatology of 209 women with HS, 77 had tattoos. None of them reported complications from being tattooed. However, having HS influenced the decision to get a tattoo for 26 participants, including 10 who decided not to get a tattoo for fears of infection, scarring, or an HS flare-up.

Can Getting a Tattoo Cause an HS Flare-Up?

Getting a tattoo can trigger flare-ups in people with chronic skin diseases such as psoriasis and eczema. While there’s limited information on tattoos specifically triggering HS flare-ups, cutting or damaging HS skin in any way can lead to more complicated cysts.

One myHSteam member shared their concerns: “If shaving brings on an outbreak, imagine what a thousand needle punctures would do. Yikes!” Another said, “It’s been my experience that the HS swelling will come back and tattoos may irritate and make HS worse.”

Understanding Koebner Phenomenon

The Koebner phenomenon is a skin reaction where new lesions develop in previously unaffected areas due to skin trauma. This process, called Koebnerization, can occur in people with chronic skin conditions, including HS. Triggers include cuts, burns, and tattoos. While it is unpredictable who will experience Koebnerization, it has the potential to worsen existing skin conditions.

HS Medications and Tattooing

Some HS medications may increase your risk of tattoo-related complications and side effects. For example, anti-tumor necrosis factor (anti-TNF) blockers such as adalimumab (Humira), which are commonly prescribed for HS, can increase your risk of fatigue, infections, and slower tattoo healing.

Tattooing To Hide HS Signs

In the study of 209 women with HS, 15 of the women got tattoos to hide surgical scars, distract from HS abscesses, or feel more in control of their bodies. While you shouldn’t get a tattoo over active HS lesions, a nearby tattoo can draw attention away from areas that commonly develop HS lesions. Be sure your skin fully heals before getting a tattoo to hide an HS surgical scar.

What Members Say

On myHSteam, members have shared their positive experiences and tips about getting tattoos to hide or distract from HS symptoms and scars:

• “Tattoos give me more control over how my skin looks.”
• “I like being able to be in control of what’s on my skin. I can do that with tattoos.”
• “If the tattoo will completely hide the scar, and that specific area won’t flare up again, I say go for it!”
• “I have tattoos on my upper body and legs. I’ve never had an issue with them, apart from occasional itching and raised ink, but I think everyone gets that!”
• “I have eight tattoos, and none of them have affected my HS in any way at all.”

How To Safely Get a Tattoo With HS

If you plan on getting a tattoo while living with HS, be sure to talk to your dermatologist first. While experienced tattoo artists can provide helpful advice to guide you in your decision-making process, a dermatology expert or other healthcare professional is the best person to assess your risks.

To reduce the risk of a skin infection and other tattoo complications, choose a licensed and trained tattoo artist who follows hygiene and safety protocols. A safe tattoo artist should:

• Wash their hands thoroughly
• Wear fresh disposable gloves
• Use clean sanitary equipment
• Sterilize reusable tools and equipment with an autoclave (heat sterilization machine)
• Disinfect all surfaces

Even with proper safety measures, your skin may react in unexpected ways. For example, allergic reactions to tattoo ink are hard to predict and can happen even years after you get a tattoo.

The Best Time To Get a Tattoo With HS

The best time to get a tattoo is when the area you want tattooed has no active HS lesions. Avoid getting a “test spot” tattoo. A test spot might not accurately predict how your skin will react to a larger tattoo. It could also sensitize you to ingredients in the tattoo ink.

Tattoo Aftercare

A tattoo can take months to heal, depending on its size and location. Proper aftercare during the healing period is just as important as preparation to reduce the risk of skin infections and other complications that can worsen HS.

Keep your tattoo covered with a bandage or adhesive barrier for at least the first 24 hours. After removing the bandage, gently clean the tattoo with mild, scent-free soap and warm water. Pat the area dry before applying a new bandage or dressing. Clean the tattoo twice a day as it heals.

When the tattoo starts to peel or scab over, avoid picking or peeling the skin. Itching is common during the healing process, but try not to scratch. A gentle moisturizer can help reduce scabbing and ease itching.

Wear loose, breathable clothing over the tattoo while it heals. Protect the healing tattoo from direct sunlight, but avoid using sunscreen until the skin has fully healed.

There is no strong evidence that prophylactic antibiotic creams (e.g., mupirocin, neomycin) after tattooing are necessary for people with HS. However, in some cases, a healthcare provider might recommend applying a topical antibiotic cream to reduce the risk of infection, especially if the tattoo is in an area prone to bacteria or if you have a history of frequent infections.

Overusing topical antibiotics can lead to antibiotic resistance, so only use them if your doctor advises it.

Consult your dermatologist for recommendations on safe antimicrobial soaps and moisturizers to use on your skin if you have hidradenitis suppurativa.

Talk With Others Who Understand

MyHSteam is the social network for people with hidradenitis suppurativa and their loved ones. On MyHSteam, more than 46,000 members come together to ask questions, give advice, and share their stories with others who understand life with hidradenitis suppurativa.

Have you considered getting a tattoo with hidradenitis suppurativa? Do you already have a tattoo? Share your experience in the comments below, start a conversation by posting on your Activities page, or connect with like-minded members in Groups.