Tattoos and Bleeding Disorders

How to enjoy body art without compromising your health
Author: Sarah Aldridge

Editor's Note: This is part 2 of a two-part series on body art. Check out part 1 on body piercings.

Tattoos not only make a statement, but also tell a story. According to a 2012 Harris poll, 20% of Americans have a tattoo. People with bleeding disorders are included in this number—demonstrating that they can also enjoy body art, with proper precautions.

Tim Andrews, 52, designed his own tattoos. His largest is a 15-inch tableau on his chest of a flaming sacred heart and banner held aloft by swallows. Andrews created it when he was the arts and crafts director at Camp Freedom in Brandon Springs, Tennessee, where he is now director. He has since shared the design with about 10 friends from camp, who have “blood brothers” written on the banner. “It’s a way to personalize yourself,” says Andrews, a business development specialist for Hemophilia Preferred Care in Memphis. “It’s a way to give a message or a cue to society.”

The green shamrock on the top of 24-year-old Michelle Finnerty’s left foot symbolizes her Irish-Catholic roots. “When St. Patrick brought Christianity to Ireland, he brought the shamrock to show the king. It represents the Holy Trinity,” says the Fowlerville, Michigan, resident, who has von Willebrand disease and is a junior psychology major at Eastern Michigan University in Ypsilanti. For Finnerty, the shamrock represents her identity. “I decided to get it because that’s my heritage, that’s my religion—that’s me.”

Some tattoos are sentimental. A lizard skitters up Andrews’ left arm. “It’s one of those little blue-tailed skinks that I used to chase when I was a kid,” he explains.

In March, Finnerty got a 6-inch tattoo on her ribcage of Missy, her beloved Dalmatian, who died in January at the age of 19.  “I kind of considered her a sibling, so I just got that to commemorate her.”

Tattoo Precautions

Although there are no federal regulations governing tattoo parlors, most states and some cities have their own. It’s a good idea to make a preliminary visit, to ensure that the facility has a permit and is inspected regularly. Observe the tattooist to see how they maintain sterile conditions and professional standards. Find out if your tattooist is a member of the Alliance of Professional Tattooists (APT). All APT members must pass a seminar on infection control and disease prevention.

But before you book your tattoo appointment, talk to your hemophilia treatment center (HTC) staff. Chances are they have experience with patients who’ve gotten body art. “Our advice is: infuse first,” says Jennifer Maahs, MSN, PNP, Indiana Hemophilia & Thrombosis Center, Indianapolis. She was a speaker for a session on body art at the National Hemophilia Foundation’s 64th Annual Meeting in Orlando in November 2012.

Andrews infused his regular factor dose the day he got each tattoo and the following day. “I had no complications because I treated them properly,” he says.

Tattooing can be traumatic, even for people with bleeding disorders who deal with routine needle pokes and pain. “The one on my chest was painful,” Andrews says.

A few minutes into her dog tattoo, Finnerty fainted. “The pain was so bad,” she says. “When it was on my rib bones, it would almost vibrate my entire sternum and rib cage.” After she came to, Finnerty saw that only one paw had been completed. She toughed it out for another 90 minutes until the whole dog was visible. The rest of the day she felt “raw,” she says.

Aftercare for a new tattoo involves washing with antibacterial soap and applying ointment, then finishing with lotion. “Your skin has to slough off that damaged layer,” says Andrews. “You have to keep it good and clean, and keep it moisturized so it won’t scab.”

Tattoo Troubles

But tattoos do have the potential to cause problems. Unsterilized needles could spread HIV, HCV and bacteria. Your body can form granulomas, small bumps around particles of pigment, or raised scar tissue. Some people develop allergic reactions to the inks or pigments.

During the last year, the Food and Drug Administration (FDA) has reported two tattoo-related skin infection outbreaks. The first occurred in August 2012 in four states after several types of nontuberculous Mycobacteria were identified in people who were tattooed. Patients developed raised red bumps where pre-diluted gray ink was used. The FDA traced the source of the infection to ink contaminated during manufacturing. Still, the outbreak was a reminder that tattoo ink should not be diluted with nonsterile water or used past its expiration date. 

The second warning was posted in March 2013, after the FDA received complaints about temporary tattoos from so-called black henna. While traditional henna, a brown dye made from a tropical plant, is typically safe for skin tattooing, black henna is not. It contains an ingredient used in black hair dye that is not approved for skin use. Skin reactions reported to the FDA included redness, blisters, weeping lesions, sun sensitivity and scarring.

Your Art Gallery

Where you hang your body art could have future ramifications. “I want to go into healthcare and possibly nursing, so I never want to ever have tattoos in places that I can’t conceal them from my work,” says Finnerty. Jeopardizing a job opportunity is a valid concern, according to a 2008 study in the Archives of Dermatology. Nearly 40 percent of people surveyed had tattoos removed because of a new job or career. Other reasons included embarrassment, problems with clothing and feeling that tattoos degraded body image.

Tattoo remorse is real. In 2011, more than 100,000 tattoos were removed by members of the American Society of Dermatologic Surgery. Such procedures can call for months of treatments that can cause bleeding, redness and soreness, and take weeks to heal.

Finnerty has been surprised by reactions to her tattoo. “When I first got the shamrock, I thought I’d have a lot more backlash from people criticizing me,” she says. “I get a lot of compliments on it, actually.”

Andrews wears long-sleeved shirts to work, so most negative reactions have come during his time off or at camp. He’s aware that parents may leap to conclusions if they see his tattoos before getting to know him. “It’s important that they trust me first,” he says.

The best overall advice: Avoid making a hasty decision when choosing your tattoo. “Wait until you’re sure you know what you want,” Andrews says. He advises campers who ogle his tattoos to wait until they’re at least 21, because what looks “cool” today might turn cold later. Andrews waited until he was 30 to get a tattoo, infused ahead of time and took care of his skin afterward. “I don’t have any regrets,” he says.

LEARN MORE

Armstrong, M, et al. Motivation for contemporary tattoo removal: a shift in identity. Archives of Dermatology, 2008; 144(7): 879-84.

Get information and find a member of the Alliance of Professional Tattooists.

American Academy of Dermatology: Tattoos and body piercings.

FDA: Tattoos and permanent makeup.