Practical Tips for Discussing Tattoos with Patients
WDS Editorial Highlight
By Walter Liszewski, MD
It is estimated that 30% of Americans have at least one
tattoo.1 As skin specialists, dermatologists can play a vital role
in helping patients obtain, maintain, and remove tattoos. Herein, I will review
several practical tips for the general dermatologist.
Tattoos are a form of personal expression.
While tattoos have historically had a negative association
in our society, this is changing. Tattoos area a form of self-expression, and
they allow individuals to modify their appearance. These motivations may not be
dissimilar from patients who undergo dermatologic cosmetic procedures. Although
we may not want tattoos others have chosen, we can objectively appreciate the
meaning they may have to that individual.
Do not be afraid to ask patients about their tattoos.
Tattoos can have tremendous emotional and personal meaning.
Patients with tattoos are often excited to talk about the motivation, significance,
and the process of acquiring their tattoo. Asking patients about their tattoos
can provide small talk during a skin check. It is also a way to develop rapport
with patients. Individuals may be afraid to discuss tattoos lest their
physician judge them. Acknowledging and complementing a tattoo can create an
open dialogue.
Ask where their tattoos were placed.
Not all tattoos have been placed in a tattoo parlor. In one
study, 17.6% of individuals admitted
to having a tattoo placed somewhere other than a parlor, such as at party or an
individual’s home.2 In these settings, proper technique may not have
been followed and needles may have been reused. For these individuals, a
discussion focused on whether testing for blood borne infections such as HIV
and hepatitis C may be needed.
Ask patients if they plan to get more tattoos.
When discussing tattoos with patients, inquiring about plans
for additional tattoos may be clinically relevant. If additional tattoos are
expected in the future, encourage patients to avoid new tattoos over nevi, confirm
that their tattoo is placed in a licensed parlor, and recommend they avoid future
tattoos if they have a history of a koebnerizing inflammatory disease. Finally,
remind patients that as skin specialists, we are trained to manage acute and
chronic tattoo complications.
Ask patients if their tattoo is symptomatic.
When it comes to tattoo complications, dermatologists may think
of acutely infected tattoos, contact dermatitis to pigments, granulomatous
reactions, and reactive keratoacanthomas. However, it is important to recognize
it is not uncommon for tattoos to chronically hurt or itch months to years after
placement.2 When a pathological cause cannot be identified, it is
helpful to reassure patients that dysesthesia of tattooed skin is a known and
not uncommon sequela.
Remember to discuss sunscreen.
Patients may not be aware that sun exposure can cause tattoo
pigments to fade. Among tattooed patients, remind them that diligent
photoprotection may not only help protect against skin cancer, it may also help
maintain the vibrancy of their tattoos.
If you remove tattoos, let your patients know.
Patients do not always tell us what they are thinking. Much
as we cannot expect all patients to tell us if they want fillers or toxins, we
cannot assume a patient who wants a tattoo removed will ask us about the
procedure. When discussing tattoos with a patient, it is okay to let them know
if you or a colleague performs tattoo removal.
References
1. The
Harris Poll. Tattoo takeover: three in ten Americans have tattoos, and most
don’t stop at just one. https://theharrispoll.com/tattoos-can-take-any-number-of-forms-from-animals-to-quotes-to-cryptic-symbols-and-appear-in-all-sorts-of-spots-on-our-bodies-some-visible-in-everyday-life-others-not-so-much-but-one-thi/.
Accessed November 9, 2018.
2. Liszewski
W, Kream E, Helland S, et al. The demographics and rates of tattoo
complications, regret, and unsafe tattooing practices: a cross-sectional study.
Dermatol Surg. 2015;41:1283-9.
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