From the Guidelines
Treating a tattoo infection requires prompt attention to prevent complications, and the most effective approach is to start with empiric therapy against Gram-positive bacteria, including coverage for community-acquired MRSA (CA-MRSA) if the patient is at risk or does not respond to first-line therapy 1.
Initial Treatment
- Clean the infected area gently with mild soap and warm water 2-3 times daily, then pat dry with a clean towel.
- Apply an over-the-counter antibiotic ointment like Bacitracin, Neosporin, or Polysporin to the affected area after cleaning, and cover with a sterile, non-stick bandage.
- Change the bandage daily or when it becomes wet or dirty.
- Take over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) as directed for pain and inflammation.
Monitoring and Seeking Medical Attention
- If the infection shows no improvement within 2-3 days, or if you develop fever, increasing redness, warmth, swelling, pus, red streaks extending from the tattoo, or severe pain, seek medical attention immediately as you may need prescription oral antibiotics.
- Infections occur when bacteria enter the skin through the tiny wounds created during tattooing, and proper treatment is essential to prevent the infection from spreading deeper into the skin or bloodstream.
- Avoid scratching, picking at the tattoo, or applying alcohol or hydrogen peroxide, as these can irritate the skin and delay healing.
Antibiotic Therapy
- For empiric coverage of CA-MRSA in outpatients with skin and soft tissue infections (SSTIs), oral antibiotic options include clindamycin, trimethoprim-sulfamethoxazole (TMP-SMX), a tetracycline (doxycycline or minocycline), and linezolid 1.
- If coverage for both beta-hemolytic streptococci and CA-MRSA is desired, options include clindamycin alone, TMP-SMX or a tetracycline in combination with a beta-lactam (e.g., amoxicillin), or linezolid alone 1.
From the Research
Treatment of Tattoo Infections
- Bacterial infections during the healing phase of tattoos can be treated with oral antibiotics, with a list of first-line antibiotics proposed 2
- Severe infections with affected general condition require intravenous antibiotic treatment as early as possible to prevent septic shock and death 2
- Hydrophilic antibiotics should be given in high load and maintenance dose due to increased renal clearance of such antibiotics 2
Management of Specific Infections
- Staphylococcus aureus bacteremia, a common cause of tattoo infections, can be treated with antibiotics such as vancomycin or daptomycin 3
- Methicillin-resistant Staphylococcus aureus (MRSA) infections can be treated with newly approved anti-MRSA molecules, such as ceftobiprole 3, 4
- Source control is a critical component of treating S aureus bacteremia and may include removal of infected intravascular or implanted devices, drainage of abscesses, and surgical debridement 3
Prevention of Tattoo Infections
- The risk of infection depends on the triad of microbial pathogen and its aggressiveness, individual resistance of the tattooed, and inoculation and exposures by the tattoo needle and in the tattoo parlor 5
- Tattoo parlors and tattooing can be hygienic and clean, albeit not sterile, and much has improved with hygiene guidelines of professional tattooists' organizations and control instituted by local and national authorities 5
- Known brands and established manufacturers of tattoo inks are considered safer, as 10% of new inks are contaminated with bacteria pathogenic to humans 5