Inking and Skin Infections

If you're considering getting a tattoo, or if you've recently gotten one and are wondering if your skin looks normal, you should learn about inking and skin infections.

Tattoos are made by placing small amounts of colored ink underneath the skin. Most often, this is done with a special machine called a tattoo gun. The machine moves a needle rapidly up and down. As it's moved across the skin, the needle injects the ink in tiny dots. A tattoo artist controls the needle, creating lines and patterns that become the tattoo.

Because the needle pierces the skin, getting a tattoo can be bloody. If the artist does it right, there shouldn't be a lot of blood, but there will usually be some. This is why tattoos carry a risk of blood-borne diseases, including HIV and hepatitis. Tattoos can also lead to skin infections, either because the needle itself carries bacteria or because the damaged skin lets infection in from other sources.

Breaking the skin is a required part of inking and skin infections are more likely to happen when skin is damaged. Normal skin provides protection from bacteria and viruses that live in our everyday environment. Any break in the skin can let bacteria or viruses in. Skin infections related to tattoos are most often caused by bacteria.

A tattoo will take several days to heal, and the skin will look red and feel tender at first. Redness may take a couple of weeks to disappear completely. Clear fluid, sometimes with a yellowish tint, may appear at first but should dry up over the first few days. However, infection can interfere with healing and make the site unusually painful. Here are some signs to look for:

• Increased pain.
• Increasing redness.
• Warmth greater than that of surrounding skin.
• Red streaks coming from the tattoo site.
• Pus or cloudy fluid coming from the tattoo area.
• A bad odor.
• Swollen lymph nodes.
• Fever.

Occasionally, the skin on top will heal while a deeper infection forms beneath the tattoo. If the site appears swollen and/or feels painful even though the tattoo itself has healed, there may be a deep infection.

In recent years, a serious infection has begun appearing in people who got illegal or home-made tattoos. The bacteria involved is called Methicillin Resistant Staphylococcus Aureus (MRSA). MRSA is difficult to treat because it's resistant to many of the drugs which doctors use to treat skin infections.

MRSA usually develops in hospitalized patients, not in the general population. That means that doctors may try to treat it like a less serious infection first, raising the risk that it could spread throughout the body and do serious damage to skin, bone, and internal organs. If you've had an illegal tattoo and develop a skin infection, be sure to tell your doctor how the tattoo was obtained.

Sometimes, an allergy to tattoo ink or to post-tattoo treatments can mimic an infection. A red ink color called cinnabar used to contain mercury, which caused skin irritation in some people. That type of ink is no longer used, but other ingredients, especially in red inks, can still trigger allergies. Occasionally, an ingredient in yellow ink will cause the skin to become very sensitive to sunlight.

Your tattoo artist will probably recommend aftercare, including cleaning the tattoo regularly and using moisturizer while it heals. You'll also be told to wear sunscreen after it's healed, to keep the ink bright. If you started using a new product after getting the tattoo and have developed red, itchy skin, try taking a break from that product or switching to a different brand.

There are always risks with inking and skin infections do require a trip to the doctor. In most cases, treatment will heal the infection without scarring. Prescription antibiotics are the mainstay of treatment.

The most common bacteria involved in skin infections are Streptococcus and Staphylococcus. Your doctor probably won't be able to tell you which one is causing your infection. Luckily, many of the same medicines work for both. Which antibiotic your doctor chooses will depend on the appearance of the infection and on infection patterns in the region where you live. Most of the time, treatment will require taking antibiotic pills for a week or two. Small, superficial infections may be treatable with antibiotic creams. Deep infections, or ones covering large areas, may require a few days in the hospital for IV antibiotics.

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