Ehlers-Danlos and tattoos

Tattoos and Ehlers-Danlos Syndrome (EDS): What You Need to Know

For people with Ehlers-Danlos Syndrome (EDS), getting a tattoo involves extra considerations due to unique skin characteristics. EDS is a group of connective tissue disorders that can cause skin fragility, hypermobility, and delayed wound healing. Here's a look at the factors you should keep in mind when considering tattoos if you have EDS.

Limited Research on Tattoos and EDS

Skin issues linked with EDS, such as hyperextensibility, fragility, and abnormal scarring, create unique considerations for tattoos and piercings. Although there’s no dedicated research on the outcomes of these body modifications in people with EDS or Hypermobility Spectrum Disorders (HSD), many individuals with mild skin symptoms report successful experiences with tattoos and piercings. However, those with more severe skin involvement, like extreme hyperextensibility or significant fragility, may experience cosmetic challenges, such as ink spread ("blowouts"), excessive scarring, or delayed healing.

Main Skin Features Linked to EDS and Tattoos

• Hyperextensibility: Common across all EDS types, hyperextensibility means the skin stretches more than usual, potentially affecting the precision and appearance of tattoo ink.
• Skin Fragility and Thin Skin: This makes the skin more prone to bruising and damage, especially with tattoo needles and the punctures involved in piercings.
• Delayed Wound Healing: Extended healing times can impact both tattoos and piercings, risking infection and potential complications if aftercare is not closely followed.
• Abnormal Scarring: Hypertrophic (raised) or atrophic (sunken) scarring is a concern, particularly around tattoos, as the needlework can intensify these scar types, sometimes creating raised or uneven ink lines over time.

Given the range of skin responses in EDS, individual experiences can vary widely. People with milder symptoms may find they heal well from tattoos and piercings, while those with more pronounced skin involvement may face some aesthetic or healing complications. Consulting with a tattoo artist or piercer experienced with sensitive skin, coupled with careful consideration of potential skin reactions, can support a more successful experience for those with EDS or HSD.

1. Skin and Healing Challenges with EDS

Skin Fragility and Elasticity
One of the defining features of EDS is skin hyperextensibility, which means the skin can stretch more than usual. While mild hyperextensibility may cause only minor issues, more severe cases can lead to tattoo ink spreading under the skin, a phenomenon known as “blowout.” This effect can cause tattoos to look blurry or bruised over time. Additionally, people with EDS often have fragile skin that is more prone to tears and bruises, especially in areas with thin skin, such as the ankles and wrists. Given this fragility, tattoos may need extra care to avoid distorting the ink lines.

Delayed Healing
For many with EDS, wound healing is slower than average. Since tattoos are, in essence, a series of controlled skin injuries, individuals with EDS may experience longer healing times, which could increase the risk of infection. Proper aftercare and closely following the tattoo artist’s instructions are crucial. Those with certain types of EDS, such as classical or vascular EDS, are especially prone to these issues due to increased skin fragility and a higher likelihood of developing scars.

2. Increased Scarring and Bruising

Scarring Concerns
Due to collagen abnormalities in EDS, tattoos may heal with unique scarring patterns. People with EDS, especially those with classical or vascular subtypes, may experience atrophic (sunken) or hypertrophic (raised) scars around tattoo lines. The frequent punctures from tattoo needles can exacerbate these scarring tendencies, making it essential to weigh the potential for raised or uneven scars when choosing the location and design of a tattoo.

Risk of Bruising
EDS often causes easy bruising, making tattoos appear more bruised or swollen in the initial days. This bruising can sometimes extend beyond typical healing patterns, so extra caution should be exercised when considering high-impact areas. Breaking up a tattoo into smaller sessions may also help reduce extensive bruising and avoid overwhelming the skin.

3. Pain Sensitivity and Management

Increased Pain Sensitivity
Many with EDS report heightened sensitivity to pain, including tattoo pain, which can make the tattooing process uncomfortable. Some people find pain management techniques helpful, such as taking shorter breaks between sessions. Consulting with a tattoo artist familiar with working on sensitive skin can also ensure a gentler process.

Nerve Sensitivity
Beyond typical pain, those with EDS often have issues with proprioception (body position awareness) and nerve sensitivity. This heightened sensitivity can make certain areas, like the wrists or ribs, feel more painful. Discussing areas of heightened nerve sensitivity with the tattoo artist can help to plan sessions that consider the most and least sensitive spots on the body.

4. Choosing the Right Tattoo Artist

Experience with Fragile Skin
Choosing a skilled tattoo artist is especially crucial for people with EDS. Many EDS patients on forums report better outcomes with artists who are experienced in tattooing fragile or sensitive skin. Look for an artist who knows how to adjust the needle depth and angle to minimize trauma to the skin.

Patch Test for Ink Compatibility
For those with skin sensitivities or conditions such as Mast Cell Activation Syndrome (MCAS), which is sometimes linked with EDS, an allergic reaction to tattoo ink is a potential concern. Consider a small patch test to check for any adverse skin reactions before committing to a larger design. Black ink is generally less reactive than colored inks, with red ink being a common culprit for allergic reactions.

5. Post-Tattoo Care

Tailored Healing Routine
People with EDS may need to adopt a more intensive aftercare routine due to slower healing and heightened risk of infection. Keeping the area clean, moisturized, and following aftercare instructions closely can help improve healing. Regular check-ups with a dermatologist if unusual skin reactions arise can also be beneficial.

Hydration and Scar Treatment
Staying hydrated and applying approved scar treatments can support skin recovery. Proper moisturization helps to keep the skin supple and may prevent some of the dryness that can accompany healing in those with EDS.

Insights from Reddit Users with EDS on Tattoos

Reddit users with EDS share varied experiences with tattoos, primarily focused on skin sensitivity, healing issues, and long-term effects:

• Healing and Scarring: Many users report that while they bruise easily and may bleed during the tattoo process, most tattoos heal relatively well. Some noted raised lines or hypertrophic (slightly bumpy) scars on the ink lines, a common skin response in people with EDS. Others observed that healing took longer, sometimes with frequent touch-ups needed over time.
• Ink Sensitivity: Several users mentioned sensitivity to specific ink colors, especially red, which caused recurring mild reactions, such as itchiness and inflammation. Some linked these reactions to skin conditions like Mast Cell Activation Syndrome (MCAS), a frequent comorbidity in EDS.
• Skin Elasticity and Ink "Blowouts": Those with particularly stretchy or "cigarette-paper" skin, often characteristic of EDS, sometimes experienced issues where the ink "bled" slightly, creating a blurry or bruised appearance. This effect, known as a "blowout," was especially common on thinner areas of skin, like the wrists and ankles.
• Finding the Right Tattoo Artist: Many emphasized the importance of finding an experienced tattoo artist, especially one familiar with fragile or sensitive skin. Working with an artist who’s patient and willing to adjust their technique, such as slowing down or using shorter sessions, helped improve the outcome.
• Mixed Long-Term Results: Some users observed tattoos that have aged beautifully, while others noted uneven fading or shape changes over time, likely due to the unique skin structure associated with EDS. Despite these challenges, many still felt the process was manageable with proper care and artist selection.

Overall, the experiences shared underscore the need for thoughtful preparation, a knowledgeable tattoo artist, and attentive aftercare for the best results.

Billie Eilish has multiple Tattoos and and EDS Trifecta Diagosis:

Billie Eilish, a global icon in music and style, is known for her distinctive tattoos, which include intricate designs such as a dragon on her hip, a bold back piece, and fairies on her hand. Her latest reveal is a tattoo on her lower stomach, which has fueled fan theories about its meaning and its potential connection to her new music era. Eilish’s tattoos demonstrate that body art can be safely managed, even with sensitive skin considerations, which is encouraging news for fans with Ehlers-Danlos Syndrome (EDS) who are considering tattoos.

While Eilish's experience doesn’t confirm safety for everyone, it suggests that with the right planning, skin sensitivities can often be managed. As always, consulting with your doctor, discussing your unique skin needs, and working with an experienced tattoo artist can help ensure a safer tattoo experience for those with EDS.

‍

Should people with Ehlers-Danlos get tattoos?

Tattoos can be a meaningful form of self-expression, and for individuals with hypermobile EDS, they’re achievable with a little extra planning. Finding an experienced tattoo artist, discussing pain management strategies, and taking an individualized approach to aftercare are all steps that can enhance both the experience and the outcome. While tattoos in EDS come with unique considerations, with the right approach, it does seem possible to enjoy body art safely and confidently. More caution is advisable for people with the rarer types of EDS like classical or vascular.

Please remember, this is not medical advice. You should always consult your doctors when making medical decisions.

‍
References:

• Nesvig, Kara. “Billie Eilish Flaunts Lower Stomach Tattoo on Close Friends Stories — See Photos.” Teen Vogue, 5 Apr. 2024, https://www.teenvogue.com/story/billie-eilish-lower-stomach-tattoo-close-friends-stories.
• Ehlers-Danlos Society. “Skin Features of EDS.” The Ehlers-Danlos Society, https://www.ehlers-danlos.com/skin/#1706026053681-34991c8b-c1a9.
• Seneviratne, Suranjith L., et al. “Mast Cell Disorders in Ehlers-Danlos Syndrome.” American Journal of Medical Genetics Part C: Seminars in Medical Genetics, vol. 175, no. 1, 2017, pp. 226-236, doi:10.1002/ajmg.c.31555.
• Tinkle, Brad, et al. “Hypermobile Ehlers-Danlos Syndrome (a.k.a. Ehlers-Danlos Syndrome Type III and Ehlers-Danlos Syndrome Hypermobility Type): Clinical Description and Natural History.” American Journal of Medical Genetics Part C: Seminars in Medical Genetics, vol. 175, no. 1, 2017, pp. 48-69, doi:10.1002/ajmg.c.31538.
• Harris. The EDS Clinic, "Ehlers-Danlos Syndrome and Skin" http://www.eds.clinic/articles/ehlers-danlos-syndrome-skin

‍