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I have been tattooing long enough to know that not every piece settles the way you want it to. Most heal beautifully. But every so often, something goes wrong, and the skin does not play along. I am not talking about a crooked line or colour fade. I mean the times when the body itself rejects the work.
The first time I saw it, I had done a red rose. The session was fine. Clean lines, solid colour. A couple of weeks later the client walked back in with a rash that covered only the red parts. The skin was raised and itchy. That was my introduction to allergic reactions to ink. Red pigments are notorious, but they are not the only ones. Yellow, green, and blue have all been linked to reactions because of metals like cadmium, chromium, and cobalt (Serup, Kluger & Bäumler, 2015; Kazandjieva & Tsankov, 2007).
For other tattoo artists: this is why you only buy your inks from reputable tattoo equipment suppliers. Clients put their trust in us. If you gamble with knock off bottles from online marketplaces, you are playing with someone else’s skin.
Tattooing is controlled injury. The needle breaks the skin thousands of times, and for most people it heals without fuss. But I have seen cases where the trauma wakes up hidden skin conditions. Psoriasis is a common one. There is a name for it in dermatology: the Koebner phenomenon. Basically, the disease flares exactly where the injury happened (Weiss, Shemer & Trau, 2002).
I once tattooed a man with no visible skin problems. Two weeks later, he came back with silver scales tracing the outline of the tattoo. His doctor confirmed psoriasis, triggered by the tattoo process. He wanted art. Instead he walked away with a diagnosis.
Not every problem is allergic. I keep a file on the 2012 outbreak in the United States. Factory sealed ink was contaminated with Mycobacterium chelonae. Dozens of people developed deep nodules and sores that would not heal (Kennedy et al., 2012). Regular creams did not work. People needed biopsies, cultures, and months of antibiotics. It made me rethink how I check every bottle I buy. If there is no sterility certificate or batch paperwork, it does not get opened in my shop.
One of my clients had a sunflower done in bright yellow. It looked amazing. But every summer it would flare up, turn red, and itch. That was not poor after care. That was the pigment itself reacting to UV light. Yellow inks with cadmium are known to cause these problems (Kazandjieva & Tsankov, 2007). Since then, I have made sunscreen part of my after care talk.
I am honest now in a way I was not early on. I tell clients that tattoos are permanent, but so are some of the risks. Allergies might show up months later. Skin conditions like psoriasis or lichen planus can flare along the lines of the tattoo. And sunlight does not always play nice with bright colours.
Most tattoos heal fine, and most people never run into these problems. But when you have seen what I have seen, you learn to respect the skin as much as the art.
BfR (2020). Tattoo inks: Safety of colourants and other substances used in tattoo inks. German Federal Institute for Risk Assessment. Available at: https://www.bfr.bund.de (Accessed: 24 September 2025).
Kazandjieva, J. & Tsankov, N. (2007). Tattoos: dermatological complications. Clinics in Dermatology, 25(4), 375–382.
Kennedy, B.S., Bedard, B., Younge, M., et al. (2012). Outbreak of Mycobacterium chelonae infection associated with tattoo ink. New England Journal of Medicine, 367(11), 1020–1024.
Serup, J., Kluger, N. & Bäumler, W. (2015). Tattooed Skin and Health. Springer, Heidelberg.
Weiss, G., Shemer, A. & Trau, H. (2002). The Koebner phenomenon: Review of the literature. Journal of the European Academy of Dermatology and Venereology, 16(3), 241–248.
