Tattoos and vascular anomalies

The question of tattoos for patients affected by a vascular anomaly is becoming increasingly important – specifically the question of whether a tattoo is even possible and if so, where. Basically, there is no scientific literature on this question and the following recommendations are only at the level of an expert’s opinion. An individual consultation is therefore always necessary.

Regardless of accompanying vascular anomalies, the creation of a tattoo is associated in not a few cases with at least temporary, usually minor side effects. In a study of more than 400 people with multiple tattoos, 42.6% of respondents stated some kind of “tattoo reaction”: temporary itching (45.7%), temporary local swelling (57%) and swelling after sun exposure (23%). A “tattoo allergy” to at least one color was found in 8% (mostly red). Persistent itching, swelling or skin infections were rare. No skin cancer was reported.

The main reaction factor, especially regarding temporary swelling, was the body area tattooed and exposure to sunlight. All tattoo reactions appear to be associated with sun exposure and individual use of sunscreen products. The more sun protection, the fewer reactions.

Therefore, it seems to be generally accepted that patients with vascular anomalies can have a tattoo on body areas not directly affected. The desire for an esthetic change of the self-image can therefore be fulfilled in many cases. Whether the esthetic evaluation of a tattoo follows the same rules throughout life is not the subject of this discussion.

However, tattoos should never be done on directly affected body areas, especially in patients with venous or lymphatic as well as arteriovenous malformations. They are locally contraindicated in the presence of pre-damaged skin, skin defects, high venous or lymphatic pressure, lymphorrhea or lymphatic vesicles or recurrent erysipelas.

Tattoos are contraindicated in the drainage area of a lymphatic malformation (increased swelling, infections) and in the area of venous malformations in which there are enlarged veins or the malformation itself is visible through the skin as a bluish discoloration. Patients under immunosuppression (e.g., with sirolimus therapy) should not be tattooed because of the increased risk of infection.

In individual cases, patients with capillary malformations have tattoos on the affected skin without increased side effects, but there are no evidence-based recommendations.

However, the most important safeguard is sufficient, consistently applied sun protection on all tattooed skin areas, at least for 3 months.