People can develop allergic reactions to the ingredients in tattoo ink. An allergic reaction to a tattoo can emerge years after a person gets tattooed. Medication may be necessary to treat the immune reaction.

A tattoo involves creating permanent markings or images on the skin by injecting ink, pigments, and dyes.

Many tattoo procedures and ingredients can be safe, but introducing foreign substances into the skin increases a person’s risk of infection and allergy.

Allergies occur when the immune system reacts to an otherwise harmless substance, causing inflammation. In the skin, this is known as allergic dermatitis. However, allergies can take many forms throughout the body depending on the type of substance and where the body comes into contact with it.

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Tattoo inks use several materials and compounds to form colors. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), the ingredients of tattoo ink are often as follows:

  • mercury for red coloring
  • cobalt for blue coloring
  • chromium for green coloring
  • cadmium for yellow coloring

In particular, the AAAAI highlights mercury in red ink as a common cause of tattoo allergy.

The Food and Drug Administration (FDA)Trusted Source has not approved any pigments or dyes as safe to inject into the skin. This means the exact ingredients of tattoo ink may not be clear. The FDA states that some tattoo inks have pigments used in commercial car paint or ink toner.

Depending on the type of immune response or physical symptoms that occur, tattoos can cause different types of allergic reactions:

  • Allergic contact dermatitis: This appears as a red rash that can be flaky or scaly, often as a response to red dye containing mercury sulfide. It may also develop from henna tattoos due to an ingredient that manufacturers mix into the dye called paraphenylenediamine.
  • Photo-aggravated reactions: This reaction involves swelling and redness or other color changes in response to sunlight exposure, usually due to yellow dyes that contain cadmium sulfide.
  • Acute inflammatory reaction: This occurs in response to a needle piercing the skin. It usually causes swelling and redness or other color changes that resolve within 2 to 3 weeks. It is a common side effect of tattooing.
  • Granulomatous reactions: These reactions are chronic inflammatory responses in which the immune system forms granulomas, or small patches of inflammation, to quarantine substances it detects as foreign but cannot remove.
  • Lichenoid reactions: These resemble lichen planus, a condition that causes a rash of purple, itchy, flat-topped bumps. They can resemble graft-versus-host disease, where the immune system attacks the body’s own tissues. They usually remain in the red areas of tattoos.
  • Pseudolymphomatous response: This condition is the immune system’s way of trying to break down the foreign material, causing red and purple plaques and nodules that resemble lymphoma symptoms but are noncancerous. Red pigment is the most common cause, but blue and green pigments may also be responsible.

Tattoos generally causeTrusted Source redness, swelling, or a feeling of warmth around the area of the tattoo. These are normal and should heal within a few weeks.

However, depending on the type of response, an allergic reaction to a tattoo may occur immediately or take weeks, years, or even decades to show symptoms. These symptoms might include:

  • redness or other color changes, like purple
  • swelling
  • itching
  • small bumps that look like pimples
  • raised scaly patches
  • blisters
  • deep lumps
  • crusting or flaky skin
  • watery, leaking fluid from the area of the tattoo

If the symptoms only affect the tattoo area, doctors consider this to be a mild to moderate reaction. More severe symptoms include the above skin symptoms as well as the following:

  • breathing difficulties
  • a very rapid heart rate
  • chest tightness
  • dizziness
  • lightheadedness
  • abdominal pain
  • severe swelling
  • intense pain
  • flushing
  • hives

Infections due to tattoos mostly occurTrusted Source when bacteria enter the skin during the needling process. However, viruses such as HIV and hepatitis can also cause tattoo infections. Infections may occur due to contaminated inks or unsanitary tattoo procedures.

Tattoo infections differ from tattoo allergic reactions, in which the immune system directly responds to the pigments in tattoo ink rather than infectious organisms or contamination. Tattoo infections are more likely to cause symptoms immediately after a tattoo or in the following days or months.

Redness and pain are natural responses while a tattoo heals. However, instead of healing, redness or discoloration may get darker and pain may worsen due to an infection. Additionally, a person may experience fever, shivering, and chills.

People who notice symptoms of an infection should seek immediate medical attention. They might need long-term antibiotic treatment to clear the infection.

People who experience symptoms of an allergic reaction may need to contact a healthcare professional.

Those with mild to moderate symptoms should discuss the reaction with their tattoo artist. The artist can recommend home care tips.

However, if milder symptoms continue beyond 1 to 2 weeks, this may indicate a tattoo allergy. If so, a person should visit a board certified dermatologist. This type of doctor specializes in skin conditions.

People who experience severe tattoo allergy symptoms need to seek urgent medical care.

The FDATrusted Source also recommends notifying the tattoo artist either way so they can identify the ink and remove it from their stock.

The need for tattoo removal depends on the allergy’s cause, type, and severity. A 2020 opinion piece from the AAAAI concludes that only tattoo removal would completely relieve allergic reactions.

Conservative treatments, such as medications, may not be an effective long-term solution. However, tattoo removal is not a solution for everyone, and it may even spread the allergic reaction by scattering pigment granules.

A dermatologist may not be able to completely remove a tattoo for some people.

A dermatologist may recommend several medications to reduce inflammation and the immune response, including:

  • corticosteroid creams
  • calcineurin inhibitors
  • crisaborole

These drugs may be effective in some people, according to a 2014 case study. Surgical methods such as cryotherapy, electrotherapy, and surgical skin removal have previously reduced allergy symptoms.

Laser therapy is another option. A 2020 study found that partially removing the tattoo with an ablative laser that removes layers of skin using a carbon dioxide laser may be the best approach, even if some pigment remains. Out of 18 people with symptoms of tattoo allergies, 15 achieved partial or complete improvement of symptoms.

A 2022 studyTrusted Source involving procedures for seven people with tattoo allergies concludes that the best-looking result was a superficial ablation that left part of the tattoo in the skin. The immune system seemed to tolerate the remaining pigment residues, and the person could keep most of the tattoo.

The American Academy of Dermatology recommends the following measures for controlling risks, reducing exposure to triggers, and preventing allergic tattoo reactions:

  • Only receive a tattoo from a state-licensed artist.
  • Carefully follow aftercare instructions from the tattoo artist.
  • Avoid sun exposure, especially during peak hours from 10 a.m. to 4 p.m.
  • Use a broad-spectrum sunscreen higher than 30 SPF and reapply every 2 hours or more.
  • Wear clothing that covers the tattoo to protect the skin.
  • Use umbrellas, trees, or other shelters for shade when outdoors.
  • Consider that living with an inflammatory skin condition, such as psoriasis or eczema, can increase the risk of a reaction.

Tattoo allergies occur when the immune system reacts to certain pigments or ingredients in tattoo ink. It can cause redness or other color changes, swelling, itching, and small, pimple-like bumps. They differ from tattoo infections, which occur due to contamination of the ink with bacteria or viruses.

Allergies may develop decades after the original tattoo, but infections develop soon after.

Different reactions occur in response to different triggers or dye ingredients. For example, sunlight can be a common trigger, and red dye is an ingredient that often causes allergic reactions.

People who experience a mild to moderate reaction should consult their tattooist and wait 1 to 2 weeks to contact a dermatologist if no healing has occurred.

Severe reactions require urgent medical treatment. Treatment may involve medications, tattoo removal, or laser surgery to remove layers of skin.