Tattooing and piercing: an underestimated issue for immunocompromised patients?

Permanent tattooing and body piercing have gained tremendous popularity in Western countries, among the young especially [1]. In France, one out of ten individuals, and one out of five among the 25–34 years old are tattooed according to a recent survey [2]. European countries have started to take actions to improve these practices by training and educating tattooists and piercers, allowing to improve the safety for customers [3,4]. Unfortunately, complications may still occur as regulations focus on the control of the infection risks. Interestingly, the potential issues related to body-art among patients with inflammatory/autoimmune disorders and under immunosuppressive therapies have been stressed only recently [5,6]. Young patients may be willing to have a tattoo or a piercing, while being under such therapy. In our experience, they do not always perceive the risks, and get tattooed/pierced without any medical advice, when the treatment is fully effective and the disease controlled especially. Intriguingly, there is to date very few cases of complications related to body-art in a context of immunosuppression. Does this mean that body-art is safe for our patients? This editorial is a viewpoint based on my own experience in the field of body-art complications, regular contact and work with tattooed individuals and tattooists of the French national tattoo syndicate and a review of the literature. Before hand, one should remember that piercing and tattooing are two totally different procedures, with different risks and complications and therefore deserving a separate discussion.