From the Guidelines
If you're experiencing a tattoo reaction, particularly from black henna, seek medical attention promptly due to the risk of severe allergic reactions and potential cross-reactions to other substances 1. When considering tattoo reactions, it's essential to understand the cause, as the immune system responds to tattoo pigments as foreign substances, causing inflammation. Black henna, which contains the chemical PPD, poses a significant risk of allergic reactions, with a reported 2.5% risk of skin sensitization 1.
Key Considerations for Tattoo Reactions
- For mild reactions, apply a cold compress and take an over-the-counter antihistamine like Benadryl (diphenhydramine) 25-50mg every 6 hours as needed for itching and swelling.
- Use a fragrance-free moisturizer like Aquaphor or Eucerin to keep the area hydrated.
- For more severe reactions with significant swelling, redness, warmth, or pus, see a doctor immediately as you may need prescription-strength topical steroids like triamcinolone 0.1% applied twice daily for 7-10 days, or oral antibiotics if infection is present.
Important Precautions
- Avoid scratching the area, exposing it to direct sunlight, or using harsh soaps that could worsen irritation.
- Be aware of the potential for cross-reactions to other hair dyes, dyes used in textiles, rubber chemicals, and local anesthetics if you've been sensitized to PPD from black henna 1. Given the potential severity of reactions, especially in children, and the possibility of long-term sensitization, it's crucial to approach tattoo reactions with caution and seek medical advice to prevent complications and ensure the best outcome in terms of morbidity, mortality, and quality of life.
From the Research
Types of Tattoo Reactions
- Allergic tattoo reactions, infections, and manifestations of autoimmune dermatoses can occur as complications of tattoos 2
- The most common skin reactions to tattoo include transient acute inflammatory reaction, superficial and deep local infections, systemic infections, allergic contact dermatitis, photodermatitis, granulomatous and lichenoid reactions, and skin diseases localized on tattooed area 3
- Chronic inflammatory black tattoo reactions (CIBTR) and allergic red tattoo reactions are the most frequent tattoo reactions, accounting for 50.2% and 18.2% of all tattoo complications, respectively 2
Clinical Aspects and Treatment
- CIBTR reactions can have extracutaneous involvement, including tattoo-associated uveitis and systemic sarcoidosis, and screening for sarcoidosis is advised 2
- The treatment of tattoo-related complications may include local destructive measures, surgical excision, and thermolysis of the pigment using Q-switched laser therapy 4
- A therapeutic scale and a decision-making algorithm can be used to manage allergic reactions to tattoos 5
Prevalence and Risk Factors
- Worldwide, 10-20% of the population is tattooed, and tattoo complications can occur in any individual, regardless of their health status 2
- Red ink is associated more frequently with long-term reactions, including granulomatous and pseudolymphomatous phenomena or morphea-like lesions and vasculitis 4
- Exacerbation of preexisting psoriasis, atopic dermatitis, and pyoderma gangrenosum may occur after tattooing 4