From the Guidelines
For an infected tattoo, the preferred antibiotic treatment is typically a combination of antibiotics that target nontuberculous mycobacteria (NTM) infections, such as amikacin, ciprofloxacin, and clarithromycin, for a minimum of 4 weeks, as recommended by the most recent and highest quality study 1. The treatment of infected tattoos can be challenging due to the variety of bacteria that can cause infections, including Staphylococcus aureus, Streptococcus species, and NTM.
- The most common bacteria causing skin infections are Staphylococcus aureus and Streptococcus species, but NTM infections are also a concern, particularly in cases where the ink or equipment is contaminated with nonsterile water 1.
- Proper wound care is also essential, including gently cleaning the area with mild soap and water 2-3 times daily, applying a thin layer of bacitracin or mupirocin ointment, and covering with a sterile, non-stick bandage.
- It is crucial to seek immediate medical attention if the infection shows signs of worsening, such as fever, increasing redness, warmth, swelling, pus, or red streaking from the tattoo, as these may require intravenous antibiotics or surgical intervention 1.
- Antibiotic sensitivity is important in designing a treatment plan, and consultation with an infectious disease expert may be necessary for suspected NTM infection in a tattoo 1.
From the Research
Preferred Antibiotic for Infected Tattoos
- The preferred antibiotic for an infected tattoo is not explicitly stated in the provided studies, but 2 suggests that oral antibiotics are used to treat bacterial infections during the healing phase of a tattoo.
- According to 3, minocycline is often preferred over trimethoprim-sulfamethoxazole or doxycycline for the treatment of community-acquired meticillin-resistant Staphylococcus aureus skin and soft-tissue infections, which can be relevant to infected tattoos.
Treatment of Infected Tattoos
- Local treatment in the healing phase of a tattoo ideally builds on the 'moist wound' principle using plastic film, hydrocolloids, silver dressing, and compression 2.
- Bacterial infections during healing are treated with oral antibiotics, and severe infections with affected general condition require intravenous antibiotic treatment as early as possible to prevent septic shock and death 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.
Common Causes of Infected Tattoos
- Skin infections are most frequently associated with Staphylococcus aureus or Streptococcus pyogenes 4.
- Tattoo-associated viral infections can be cutaneous and localized to the tattoo ink, and viral pathogens acquired during inoculation can cause systemic disease 5.
Important Considerations
- Chronic allergic reactions in red tattoos are mostly nonresponsive to topical corticoid and best treated with dermatome shaving with complete removal of the hapten concentrated in the outer dermis 6.
- Laser treatment of allergic reactions can boost the allergy with worsening and a potential risk of anaphylaxis and is thus not recommended in tattoo allergy 6.