Thinking of a Tattoo? What doctors want you to know before getting inked

As tattoos grow in popularity, dermatologists warn of overlooked risks linked to hygiene, ink composition, immune reactions and long-term skin health

Tattoos have moved firmly into the mainstream, with people of all ages choosing body art to mark milestones, memories or personal beliefs. Yet behind the creativity lies a medical reality that is often glossed over.  Tattooing involves repeatedly puncturing the skin and permanently depositing foreign pigments into the body, a process that can carry real health risks if not approached carefully. Doctors say many complications are preventable, but only if people understand what they are signing up for.

 

Common risks that are often underestimated

 

According to Dr Smriti Naswa Singh, Consultant – Dermatology, Fortis Hospital Mulund, Mumbai, the most frequent complications seen after tattooing include infections, allergic reactions, scarring, and keloid formation (a thick, raised scar that grows beyond the original wound).

 

 

“The most common complications seen after tattooing are skin infections, allergic reactions to tattoo pigments, scarring and keloid formation, and blood-borne infections when sterile practices are not followed,” she says.

 

As tattoo needles breach the skin thousands of times, poor hygiene can lead to anything from local redness and pus formation to deeper infections such as cellulitis, a skin infection caused by bacteria, which may require hospitalisation and intravenous antibiotics. People with weakened immunity face an even higher risk.

 

Permanent scarring is another overlooked issue, especially in those prone to hypertrophic scars (thick, raised scar formed from excess collagen, within the original wound's boundary) or keloids, where thick, itchy and painful scars can extend beyond the tattoo itself.

 

Infection risks and why studio hygiene matters

 

The risk of blood-borne infections such as hepatitis B, hepatitis C, and, rarely, HIV is real. However, experts stress it is linked to unsafe practices rather than tattooing itself.

 

Dr Singh explains that studies show people with tattoos have a higher prevalence of hepatitis B or C, particularly when tattoos are done outside licensed studios or in settings with poor regulation.

 

True hygiene standards should include:

 

• New, sealed, single-use needles and ink pots opened in front of the client
• Strict glove use and clean work surfaces
• Proper sterilisation of reusable tools using autoclaves or approved methods
• Safe disposal of sharps and contaminated waste

 

Vaccination against hepatitis B is strongly advised before getting a tattoo, as it offers direct protection against one of the most transmissible viruses in this context.

 

Allergic and delayed immune reactions to tattoo inks

 

Tattoo inks are complex mixtures of pigments and additives, and allergic reactions are common, particularly with red, yellow and green inks. These reactions may show up immediately as itching, rashes or swelling, or appear months or even years later.

 

“This happens because tattoo ink is permanently deposited in the skin and acts as a foreign substance,” Dr Singh explains. “The immune system may continue to react against it over time.” In some cases, this leads to chronic eczema-like inflammation or granulomas (firm nodules forming within the tattoo) long after the tattoo appears healed.

 

Chronic skin conditions and flare-ups

 

Tattooing can also trigger or worsen existing skin diseases through a process known as Koebnerisation, where skin trauma sparks disease activity. Conditions that may flare include psoriasis, eczema, lichen planus, sarcoidosis and viral warts.

 

Dr Neeharika Goyal, Consultant-Dermatologist at Svastam Wellness, New Delhi, notes that people with autoimmune conditions, sensitive skin, darker skin types or a family history of scarring are particularly vulnerable. Those prone to keloids face a higher chance of developing thick, expanding scars after tattooing.

 

What happens to tattoo ink inside the body?

 

Research has shown that tattoo ink particles can migrate from the skin to nearby lymph nodes. Biopsies and imaging have confirmed this movement, but doctors say the long-term health implications remain unclear.

 

Most particles are filtered by immune cells, and while some pigment components may break down into chemicals linked to cancer, current clinical evidence has not conclusively shown major long-term harm in real-world populations. Still, scientists continue to study whether chronic inflammation or cumulative exposure could pose risks over decades.

 

Health records do not routinely record whether a person has tattoos, making it difficult for researchers to track long-term health patterns or establish clear links over time.

 

MRI scans, cancer fears and detection challenges

 

Some tattoo pigments contain iron or metallic particles, which can occasionally interact with MRI scanners. This may cause a mild burning or tingling sensation at the tattoo site or, rarely, distort images. Such complications are uncommon, but patients should always inform MRI technicians about their tattoos beforehand, says Dr Singh.

 

Tattoos can also complicate skin cancer detection. Dr Goyal shares that large or heavily pigmented tattoos may obscure moles or subtle changes in colour, shape or size, especially important when monitoring for melanoma. Dermatologists may need biopsies or serial photographs to track suspicious areas within tattooed skin.

 

Laser tattoo removal is not a simple fix

 

Laser tattoo removal is often marketed as straightforward, but doctors caution otherwise. Even simple black tattoos usually require six to eight sessions or more, spread over many months. Multi-coloured tattoos, especially red, yellow and green, are far harder to remove and may never fully clear.

 

Possible complications include:

 

• Burns and scarring
• Persistent light or dark pigmentation changes
• Allergic flare-ups during ink breakdown
• Incomplete removal despite multiple sessions

 

Breaking tattoo ink into smaller particles during laser removal may increase its movement through the lymphatic system or chemical exposure in the body. Multiple sessions also add to the cost and can increase the risk of prolonged skin healing problems for some patients, says Dr Goyal.

 

How to reduce tattoo-related health risks

 

Experts recommend a cautious, informed approach:

 

• Choose only licensed, well-reviewed studios with visible hygiene protocols
• Avoid tattooing if you have active skin disease or a history of keloids
• Ask about ink composition and avoid unnecessary colours
• Ensure hepatitis B vaccination is up to date
• Follow aftercare instructions carefully and seek medical advice if reactions occur

 

Tattoos may be personal and expressive, but doctors stress they should never be impulsive. Understanding the risks can help people make safer choices and avoid regrets that go far deeper than the skin.     

For more health updates, follow #HealthwithBS

This report is for informational purposes only and is not a substitute for professional medical advice.