One of my patients recently asked me whether I would have any objections to him getting another tattoo. The plan seems to be for a somewhat larger piece and he had previously had some intense discussions with his doctors – in principle, they had advised him against it, which he did not want to accept. Therefore, I was supposed to give a final answer to this question.You can’t deny it – with this topic, you obviously run the risk of expressing yourself more emotionally than based on facts. So, I was actually quite proud that my opinion was even asked for, because at first glance, I certainly don’t look like a fan of body art – I’m rather a bit more conservative.
On the other hand, statistics show that 10% – 20% of the German population are now tattooed – so many people like it. Therefore, it would indeed not be fair to use only one’s own taste standards when making a recommendation. Hence, here is an attempt at an objective consideration:
It is most likely that tattoos should not have a negative effect on Multiple Sclerosis. However, especially poor hygiene during tattooing can pose significant health risks – but this applies to anyone who gets a tattoo, not just specifically for MS patients. In the worst case, serious infectious diseases such as hepatitis (liver inflammation/jaundice) or HIV can be transmitted due to poor hygiene. Another danger is that during tattooing, germs that normally settle on the skin can be carried into the tissue and can cause inflammation here – if you’re unlucky, up to an abscess or erysipelas. Such serious skin infections always also carry the risk of a deterioration, the MS (pseudo-relapse). With good hygiene, these dangers can be significantly minimized, although they can never be completely ruled out. Therefore, one should pay attention (especially as an MS patient) to the cleanliness and sterility of the studio when choosing it and that the operator can prove a hygiene training.
There are certain conditions that can also affect MS patients, where I would also refrain from getting a tattoo against the background of the potential risk of infection. This includes pregnancy, the intake of blood-thinning agents and patients with diabetes mellitus, who already have a higher risk of skin infections due to diabetes. If you already have a skin disease (e.g. neurodermatitis, psoriasis), you should definitely consult a dermatologist.
Of course, one is a bit concerned when dealing with the ingredients of tattoo inks – even though this also does not specifically affect MS patients. Some colors contain allergenic substances, azo dyes or aromatic hydrocarbons, which are suspected of causing cancer. One can only hope that something has actually changed here in recent years. In any case, you should inform yourself thoroughly and make sure that only tested, “safe” colors are used. Therefore, careful selection of the tattoo studio is recommended here as well – in case of doubt, money should not play too decisive a role for the sake of safety.
As an MS patient, you should also not forget that you have to go for MRI more often than the normal population. Therefore, it is important to avoid colors that contain metal pigment. These can heat up in the magnetic field of the scanner – and indeed there are reports in the literature about large-scale burns in tattooed patients after an MRI examination. This danger should also be taken into account when choosing the colors.
Of course, it should also be pointed out that a tattoo can make it difficult to insert access (for infusions) and that skin cancer screening is also made more difficult by tattoos – this naturally applies to everyone again.
Finally, the question of medication is important. Due to the potential risk of infection, patients with immunosuppressive medication are generally advised against tattoos. Well, classic immunosuppressants such as Endoxan, Mitoxantrone, Azathioprine or Methotrexate are rarely given for MS these days – this recommendation would apply to these medications.
This recommendation does not necessarily have to be extended to the large number of MS patients who take specific MS medications that also affect the immune system. With MS drugs like interferons and glatiramer acetate, but also dimethyl fumarate and natalizumab, no problems are likely to be expected due to their mode of action. With drugs like fingolimod and aubagio, but also alemtuzumab and rituximab, I wouldn’t 100% sign that off due to the mechanism of action. Ultimately, it remains a personal “benefit-risk” assessment here.
So, the following conclusion can be drawn: The presence of MS is certainly not a hindrance to getting a tattoo. However, especially as an MS patient, one should be particularly critical and cautious regarding hygiene and the choice of colors used.
