Tattoos have become an exceedingly common practice. Its increased prevalence has led to a rise in report of cutaneous reactions.

For patients with severely infected tattoos, antibiotic treatments may last for weeks or months.

Transient acute inflammatory reactions, superficial and deep local infections, systemic infections, allergic contact dermatitis, photodermatitis, granulomatous and lichenoid reactions have all been extensively reported in the literature. According to Dr Pumeza Makaula, of the University of KwaZulu-Natal, a 59-year-old female presented with acute swelling over a multicoloured tattoo on her right ankle and leg immediately following the tattooing procedure, with subsequent development of painful nodules only within the red-inked areas.

Histology demonstrated features of keratoacanthoma within the red-inked-areas. Keratoacanthomas (KAs) are squamous cell neoplasms of unknown origin that grow rapidly. They may be single or multiple and numerous types have been described including trauma-induced KAs. While there have been a few reports of KAs arising within tattoos, it is an extremely rare occurrence. This case therefore displays a very unusual clinical presentation of a reaction to tattoo ink.


The most common symptom of a tattoo infection is a rash or red, bumpy skin around the tattoo area. In some cases, the skin may be irritated because of the needle, especially in sensitive skin. If this is the case, symptoms should fade after a few days. But if these symptoms continue for a week or more, look out for the following in patients:

  • Fever
  • Feeling waves of heat and cold
  • Abnormal shivering
  • Swelling of the tattooed area
  • Pus coming out of the tattooed area
  • Red lesions around the tattooed area
  • Areas of hard raised tissue.


A staph infection is one type of infection that might arise with a tattoo. Staph bacteria, especially methicillin-resistant staphylococcus aureus (MRSA), can also get into the bloodstream and internal organs. When this happens, other conditions can develop, such as sepsis, arthritis, and toxic shock syndrome. Some common symptoms of staph infection include extreme thirst, aches or pains in bones or muscles, high fever of 38.90 or more, swelling of the infected area, sores that are in the infected area and filled with pus or fluid, impetigo and diarrhoea. This needs to be treated immediately.


Minor bumps and rashes can usually be managed at home with antibacterial ointment, proper cleaning, and rest. In an infection, treatment depends on the cause. A biopsy will indicate what bacteria or virus is causing the infection. In most cases, antibiotics will stop the infection. In severe cases of infection, antibiotic treatments may last for weeks or months. In rare cases of infection, surgery can be required to repair the tissue. In cases of necrosis, surgery may be needed to completely remove the infected tissue. Persistent, sometimes itchy, and painful bumps in the tattoo may be signs of an atypical mycobacterial infection. This requires long-term antibiotic treatment.