Date: 04/15/2025

By FIRST member Lea Ayer

Can people with ichthyosis get tattoos? Absolutely! I am currently 45 years old with ARCI, and I have multiple tattoos on different parts of my body, including a full sleeve on my left arm, as well as on my hands and feet. Some of my tattoos are black and white, but most of them are color. I got my first tattoo in 2014, and my most recent tattoo near the end of 2024. 

The most difficult thing about getting a tattoo with ichthyosis is getting the ink the right depth in our skin. Tattoos work by depositing ink through the epidermis (top layer) into the dermis of the skin. If a tattoo isn’t deposited deep enough through the epidermis, it will “fall out” and the ink won’t stay where it was placed. If ink is placed too deep and goes through the dermis into the fatty layer, it will spread out from the intended place, looking blurry and muddy, and is called a “blowout.” Since ichthyosis skin tends to be thicker than most people’s skin, the tattoo artist may need to use a little more pressure than normal in order to get the tattoo to look right, but not too much pressure to create a blowout. When working with a new artist, I let them know that my skin is thicker than most people’s. They usually find that out anyway when they start working on me! 

To prepare for a tattoo, I first have a consultation with the tattoo artist. I let them know the design I would like, and where I would like to have it on my body. I also let them know about my skin condition. They give me feedback on my idea, as sometimes the placement and design may not work due to the shape of various body parts or the detail on my design idea. For example, if I wanted a small, intricate flower and a quote written on the back of my hand (and we all know how our ichthyosis hands look), my artist may tell me that something that small in that area would be blurry. They may suggest making the design bigger and placing it on a different area of my body that has more room. Or if I was set on a hand tattoo, they may suggest a different design, using my original idea as inspiration. 

Once we have the idea set and an appointment made, I prepare my skin. A few days before my appointment, I exfoliate the area daily, sometimes twice a day, and apply my lotions of choice multiple times a day to keep the skin supple. Personally, I use CeraVe mixed 50/50 with glycerin, or Aquaphor, depending on the body part. I drink lots of water to keep my body well-hydrated, too.  

The day of my appointment, I continue to drink lots of water and apply my lotions frequently throughout the day leading up to my appointment time. I also make sure to eat a good meal prior to my appointment to keep my energy level up and prevent my blood sugar from dropping. Tattooing, especially if it’s a large tattoo, can be traumatic to anyone’s body, whether they have ichthyosis or not. You’re basically creating a large wound on your skin. I bring a water bottle and some snacks with me to my appointment as well, because tattoo sessions can last for hours. My smallest, simplest tattoos only took about 5 minutes to do. My longest tattoo session was 6 hours! 

When you arrive to your appointment, your artist will shave the area and wash it with green soap. Some artists may ask you to arrive to your appointment with the area already shaved. This allows the artist to work on your skin without body hair (and flakes) getting in the way. They will apply the tattoo stencil to your skin and give it a few minutes to dry. It’s important to not touch the stencil after it’s been applied, because you don’t want to rub it off. Your artist will have you check the stencil in the mirror to make sure you are happy with how it looks on your skin. If you don’t like how it looks where it is at, let them know now! They can wash it off and re-apply it the way you like it. This is also the time to carefully double-check any dates and words for errors, because once the tattoo is on there, it will be like that forever! 

The artist will then place you in the chair, helping you get situated the way they need you to be to best access the area for the tattoo and to ensure you are comfortable. The artist will start with what is called “line work” and begin tracing the lines of the stencil with black ink using a small needle. Then they will color in or shade the tattoo with a wider needle, basically a bunch of small needles bunched together. To me, this feels like cat scratches. Some people say it feels like a bee sting over and over. As far as pain levels go, it changes depending on the area of the body, the size and detail of the tattoo, and your own tolerance levels. The inside/outside of the elbow and knee, sternum/stomach, and feet tend to hurt the most. Upper arm, thigh, and calf areas tend to hurt the least. Basically, bony areas of the body are more sensitive than thicker areas! 

Because of the thickness of Ichthyosis skin compared to unaffected skin, the artist may need to press harder than they usually do for other clients. During my first tattoo, my artist told me, “I was starting to feel bad for you, because I had to go over each area three times to get the ink to stay!” Once he got used to how my skin took ink, he was able to tattoo me with no problems.  

The artist will wipe the area frequently with a mixture of soap and water on a paper towel. This helps wipe away excess ink as well as keeping the skin hydrated. If your skin is starting to feel dry, you can definitely ask your artist to wipe more frequently. Some artists will also use a small amount of Vaseline or Aquaphor on the area as they are tattooing. There are some artists who prefer to “dry wipe” using only a dry paper towel to wipe excess ink away. Tattoos are painful enough as it is, even for people who aren’t affected by Ichthyosis, and dry wiping makes it hurt even more. If, during the initial consultation, an artist says they only dry wipe, I don’t book with them. I’m not going to put my skin through more trauma than needed to get a tattoo! 

After the tattoo is finished,  DO NOT TOUCH IT! You’ll be tempted to as you look in the mirror and admire your new art, but remember this is a fresh, open wound on your skin. Your artist will put a thin layer of Vaseline, Aquaphor, or other lotion over the tattoo and wrap it in plastic wrap or a tattoo bandage to protect it. Your artist will give you after-care instructions, and these can vary by artist. However, sometimes the after-care instructions that the artist provides do not do well for ichthyosis skin—such as dry healing (which means not putting any lotion on), using only a light lotion sparingly, or keeping the tattoo completely covered at all times. 

Here’s my after-care routine. I leave the plastic wrap on the tattoo for a few hours after leaving the tattoo studio. Then I take it off and gently wash the area with antibacterial soap and pat it dry. Do not rub the tattoo or put any pressure on it until it heals. I put a very thin layer of Aquaphor on it to keep it moisturized. I gently “tap” the Aquaphor on so I’m not rubbing the new tattoo. I try to keep the area clean and uncovered by clothing the best I can. I do this 4-5 times a day for the first three days. Warning, during the first night, you might have some ink transfer from your tattoo to your clothing or sheets! When I got my planchette and eye tattoo on my inner bicep, I woke up the next morning to a perfect eye imprint on the side of my tank top!  

After 3-5 days, your tattoo will start to peel. This may be a few days earlier than what the after-care instructions your artist gave you. But healing is our super power, and ichthyosis skin heals tattoos fast, too! The peeling will look a lot like how your skin peels after a sunburn. It is very important to NOT pick off the skin flakes. Let them fall off naturally. Keep gently patting Aquaphor on the tattoo to keep the area moisturized, don’t rub it and don’t itch it. It WILL itch, sometimes badly. It’s very important to not scratch the healing tattoo. You will also see some ink come up in the peeling flakes. That, too, is normal. Not all of the ink will come up. If it does, that means that your artist didn’t get deep enough into your skin to set the ink and you’ll need to go in for a touch-up. That happens to unaffected skin as well.  

Because ichthyosis skin heals quickly, the peeling stage usually only lasts a few days (much shorter than typical after-care instructions state). After it’s done peeling, it may still itch for a few more days, but don’t scratch it! After about a week, your tattoo will be fully healed and you can go back to your normal ichthyosis care routines.  

But caring for your tattoo with ichthyosis skin doesn’t just end after healing. It’s important to keep the area well-moisturized to keep your tattoos looking their best. When I’m having a bad skin day, my tattoos tend to look ashy and aren’t as bright as people who have unaffected skin. Applying my CeraVe mixed with glycerin helps to brighten the tattoo again. It’s also important to keep your tattoo protected from the sun with sunscreen or clothing. Sunlight can fade tattoos, especially color tattoos, and if you have white ink in your tattoo, the sun can make it turn yellow. 

I love all of my tattoos, and they have all been an experience! I do plan to get more in the future, too. Happy tattooing!