From the Guidelines
For a tattoo that is persistently infected despite first-line treatment, it is crucial to seek immediate medical attention from a dermatologist or infectious disease specialist to prevent serious complications. The recommended approach typically involves taking a culture sample to identify the specific bacteria causing the infection and determine antibiotic sensitivity, as guided by the Infectious Diseases Society of America 1.
Key Considerations
- The infection could be due to contaminated equipment, poor aftercare, or bacteria resistant to initial treatments.
- In severe cases, intravenous antibiotics might be necessary, and options such as high-dose daptomycin in combination with another agent should be considered if the isolate is susceptible 1.
- Keeping the area clean by gently washing with mild soap and water twice daily, avoiding scratching or picking at the tattoo, and applying prescribed medications as directed is essential for recovery.
Treatment Approach
- Oral antibiotics such as doxycycline or ciprofloxacin may be prescribed for 10-14 days, combined with topical antibiotics like mupirocin ointment applied three times daily.
- In cases of methicillin-resistant Staphylococcus aureus (MRSA) infections, management may involve removal of other foci of infection, drainage, or surgical debridement, as well as consideration of alternative antibiotics such as quinupristin-dalfopristin, TMP-SMX, linezolid, or telavancin 1.
Importance of Prompt Treatment
- Persistent infections can lead to serious complications including scarring, tattoo distortion, or systemic infection, making prompt professional treatment essential.
- A careful history, including information about the patient’s immune status, geographical locale, travel history, recent trauma or surgery, previous antimicrobial therapy, lifestyle, hobbies, and animal exposure or bites, is key to developing an adequate differential diagnosis and an appropriate index of suspicion for specific etiological agents 1.
From the Research
Treatment of Infected Tattoos
- Infected tattoos can be caused by various bacteria, including Gram-positive and Gram-negative aerobic and anaerobic bacteria 2.
- Ceftriaxone, a third-generation cephalosporin, has been shown to be effective in treating various infections, including skin and soft tissue infections 2, 3.
- A fixed-dose combination of ceftriaxone and vancomycin has been found to be effective in treating various bacterial infections, including skin infections, without any toxic effects on the liver and kidney 3.
Persistence of Infection Despite Treatment
- Despite treatment with antibiotics, some infections can persist, and the choice of antibiotic and treatment duration can play a crucial role in resolving the infection 4.
- Recent studies have shown that shorter treatment durations can be effective for common infections, including skin and soft tissue infections, and can help reduce the risk of antibiotic resistance 4.
- However, there is limited evidence specifically on the treatment of infected tattoos, and more research is needed to determine the most effective treatment strategies for these types of infections.
Considerations for Treatment
- The choice of antibiotic and treatment duration should be based on the severity of the infection, the type of bacteria causing the infection, and the patient's overall health status 2, 3, 4.
- Clinicians should consider the potential for antibiotic resistance and the need for shorter treatment durations to minimize the risk of resistance 4.
- Further research is needed to determine the most effective treatment strategies for infected tattoos and to provide guidance on the optimal choice of antibiotic and treatment duration.