There’s a lot of confusion about whether tattoos cause keloids. Some warn that you should never get a tattoo if you’re prone to this type of scar tissue.
If you’re unsure about whether it’s safe for you to get a tattoo, keep reading to learn the truth about keloids and tattoos.
A keloid is a type of raised scar. It’s made up of collagen and connective tissue cells called fibroblasts. When you’re injured, these cells rush to the damaged area to repair your skin.
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You can also get a keloid from a tattoo. To seal the ink into your skin, the artist pierces your skin again and again with a needle. This process creates many tiny injuries where keloids can form.
Keloids are hard and raised. They have a smooth and shiny surface, and they can hurt or itch. Keloids stand out, because they’re typically reddish-brown and end up longer and wider than the original area of injury.
A hypertrophic scar forms when there’s a lot of tension on a wound that’s healing. The extra pressure makes the scar thicker than usual.
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The difference is that keloid scars are bigger than the area of injury and they don’t fade with time. Hypertrophic scars are only in the wound area and do tend to fade with time.
Your artist may be able to use an ink that’s less likely to show on your skin — like white ink on pale skin tones — to tattoo a dot or a small line. If you don’t develop any scar tissue during the healing process, you may be able to get a tattoo here or elsewhere.
The practice of inking over a keloid is called scar tattooing. It takes a lot of skill and time to safely and artfully tattoo over a keloid.
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If you’re going to tattoo over a keloid or any other scar, wait at least one year to make sure your scar has fully healed. Otherwise, you might reinjure your skin.
Choose a tattoo artist skilled at working with keloids. In the wrong hands, the tattoo might damage your skin even more and make the scar worse.
If you already have a tattoo, watch for thickening skin that looks rounded over the inked area. That’s a sign that a keloid is forming.
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If you do see a keloid start to form, talk to your tattoo artist about getting a pressure garment. These tight clothes may help minimize scarring by compressing your skin.
Cover up the tattoo with clothing or a bandage whenever you go outside. UV light from the sun can make your scars worse.
As soon as the tattoo heals, cover the area with silicone sheets or gel. Silicone can help slow the activity of fibroblasts and collagen formation, which cause scarring.
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Silicone sheets reduce the production of collagen, the protein that comprises scar tissue. They also prevent bacteria from getting into the scar. Bacteria can trigger excess collagen production.
You can also see a dermatologist with experience treating keloids — specifically tattoo-related keloids, if possible. They may be able to recommend other reduction techniques.
There’s no solid evidence that over-the-counter creams like vitamin E and Mederma shrink scars, but there generally isn’t any harm in trying.
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Keloids aren’t easy to get rid of permanently. Your provider may need to use more than one of these methods to fully remove the scar — and even then it may come back.
Keloid removal can also be expensive. It’s generally considered to be cosmetic, so insurance may not cover the cost. Your insurer may consider paying for part or all of the removal process if the scar affects your movement or function.
Removing a keloid that has grown on a tattoo may have a negative effect on the ink. It ultimately depends on how close the keloid is to the tattoo and which removal technique is used.
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Using more than one treatment method can increase the likelihood of permanent removal. For example, getting corticosteroid injections or cryotherapy and wearing pressure garments after surgery can help reduce your risk for return.
Has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Scars from tattoos are a rare problem, but when they happen they can override all the positive benefits of these ancient forms of body art. Like scars caused by injury or surgery, a tattoo scar can never be fully removed once it happens. So, understanding your own personal risks for getting scars from tattoos is worth doing before getting inked.
A tattoo scar is created in the same way all scars are formed. Anytime an injury occurs within the skin layer called the dermis, the body’s repair mechanism kicks in to heal the wound by forming scar tissue. Because tattoos are created by penetrating the skin’s dermis repeatedly with the tattoo needle, scars from tattoos actually arise with every tattoo. But, in the vast majority of cases, tattoo scar formation is so pinpoint and minor that it is imperceptible and poses no problem whatsoever. In rare cases, however, a tattoo scar can arise that is much more noticeable. There are 3 main reasons this can happen:
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The extent to which skin scars from tattoos or any other injury depends on the depth in the skin the damage reaches. An ideal tattooing technique has the needle penetrate into the very upper layer of the skin’s dermis. If the tattoo is overworked and the artist penetrates the needle deeper in the dermal layer, a greater scarring reaction is provoked. This can cause a tattoo scar that is visible, in the same way a deeper incision or laceration leaves a visible scar. So, in summary, tattooing too deep into the skin is a technical cause of scars from tattoos.
Tattoo needles that penetrate the upper dermis (black) leave scars but they are essentially invisible. Penetration into the deeper dermis (orange) provokes scars that can be much more visible.
Tattoo scabbing is a normal part of tattoo healing. The multitude of skin penetrations by the tattoo needle provoke bleeding during the procedure, and similar to other injuries that bleed, a scab forms. Because the tattoo needle creates so many tiny skin injuries that bleed, tattoo scabbing can be extensive, covering the majority of the inked area. It’s important to care for tattoo scabbing correctly to avoid the scabs tearing off which can both damage the tattoo and provoke scarring.
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Tattoo bubbling is when tattoo scabbing becomes water-logged. Significant scabbing traps water from washing and showering. Application of tattoo lotion exacerbates the problem by placing a waterproof layer over the water-logged scabs so that normal drying by evaporation doesn’t happen. When tattoo scabbing becomes saturated with water, tattoo bubbling occurs and the scabs become boggy and sticky. This can be a problem because the scabs will be more likely to come off with even gentle contact. That can lead to damage to the tattoo art and also provoke scarring. Tattoo bubbling is also easy to get caught on clothing which can pull scabs off. Here are some pointers to help avoid problems related to tattoo bubbling:
Red pigments have been shown to be the most likely color to cause a tattoo allergy. Allergic reactions can cause various degrees of skin inflammation and irritation from mild redness and itching to severe dermatitis. In some cases, the allergy is made worse in sunlight, and some allergies only come on years after the tattoo was done. When a severe allergic reaction occurs, skin inflammation can cause damage to the skin that could lead to scarring. Also, itchiness associated with tattoo allergy can provoke scratching which can dislodge scabs or damage the skin in other ways that could provoke a tattoo scar to form. If you believe you are experiencing a tattoo allergy:
A tattoo infection can present itself as spreading redness, warmth, increasing pain, and tenderness. Symptoms can then progress to fever and general unwellness if not treated. Infection can cause scars because of the inflammation and additional scabbing it causes. Both can damage deeper skin layers and provoke a noticeable tattoo scar. To help avoid a tattoo infection, take it upon yourself to:
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Tattoo granulomas can form as a result of the body reacting to pigments in the ink. This is similar to how your skin would react to a splinter that is not removed. Inflammation and bumpy growths that are either minimal or quite extensive are the results. Tattoo granulomas often occur only in parts of a tattoo that are of a certain colour. This is because different colours are composed of different types of metallic ions that the skin may or may not react to. Tattoo granulomas can be difficult to treat and may need intervention by your doctor such as cortisone injections or even tattoo removal. Scars from tattoos can result from tattoo granulomas because of the inflammation and damage the granulomas can cause to the deeper dermis of the skin.
How any individual is “programmed” to heal is determined by an incredibly complex interaction of factors such as
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