Tattoos and permanent cosmetics while on Isotretinoin treatment for acne

by Tat2Duck

What is Isotretinoin?

Isotretinoin is the generic name for prescription oral medication that treat severe acne. Commonly prescribed isotretinoin brands are Accutane®, Amnesteem®, Claravis® and Sotret®.

Isotretinoin is a synthetically manufactured retinoic acid derived from vitamin A and naturally manufactured by the liver in small quantities. It is effective in the treatment of severe acne due to the chemical's inherent ability to reduce sebum oil production by shrinking oil glands. Other properties inherent with the drug are also present but for the purpose of this article, I will keep it simple.

What is Retinoic Acid?

Retinoids are a class of chemical compounds related chemically to vitamin A. They exert intense multiple effects in skin, affecting many aspects of cell differentiation (the modification of body parts for performance of particular functions) and proliferation (the rapid and repeated production of new parts). Because of its diverse effects in skin, retinoic acids have been beneficial in the treatment of various skin disorders particularly with severe acne, hyper-pigmentation as well as certain forms of cancer.

With severe acne, retinoids target sebocytes and act as a powerful sebo-suppressive which restricts lipid synthesis. Lipids are naturally occurring molecules which include fats, waxes, sterols, fat-soluble vitamins and others. The side-effect to this metabolic change is that it dries the skin, inhibiting the growth of acne bacteria. This is obviously an over-simplification of the process, but you get the idea.

How Retinoids affect skin getting tattooed

As mentioned above, retinoids exert intense effects in skin cells. Of particular issue with patients undergoing retinoid treatment is hyperplasia; the abnormal multiplication of normal tissue caused by damage to the skin. This proliferation has been noted in keratinocytes, the epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal (lower) layers of the epidermis to the cornified (outer horny) layer of the skin.

In simple terms, it means that the damage caused by the needle may create unusually greater amounts of scar tissue than would normally appear on a person not undergoing retinoid treatment. A tattoo resides within this region and is directly affected by this proliferation.

In browsing through various medical blog sites and message boards, I found there is a very broad consensus about when to get a tattoo after undergoing retinoid treatment. This leads me to suspect that the mixed reactions are due to the variance in individual physiologies. As with the acknowledged side effects of retinoids and the diversity in individuals being so extensive, so are the affected results of tattooing on patients that have undergone retinoid treatment.

The manufacturers of Isotretinoin clearly warn against undergoing “cosmetic treatments that smooth your skin, including waxing, dermabrasion, or laser procedures, while taking Isotretinoin and for at least 6 months after you stop. Isotretinoin can increase your chance of scarring from these procedures”. While it does not list tattooing in that warning, common sense dictates that as a cosmetic procedure by definition, tattoos should be avoided for at least 6 months after you stop taking Isotretinoin.

Aside from scaring, I found that many of the posts indicate a lowered level of pigment retention in a tattoo. Typical complaints have indicated that tattoos done during or shortly after ending treatment have healed poorly and often needed extensive touch up. On reading the known side effects of retinoids, I found that there are certain hematological side effects that may indirectly influence pigment retention which include anemia, reduced white cell counts and increased platelet counts.

Initial problems I see that would cause irregular healing of a tattoo would be from too much bleeding during the tattooing process. Since hemostasis is not maintained, inks can become too diluted causing them to heal irregularly or faded. The increase in platelets can also be of concern as the increase in extracellular matrix proteins can have a severe influence on how the pigment is retained in the skin. While I was unable to find proof of this, my understanding of the procedure leads me to think that there may be a link there.

Overall recommendations

Since a tattoo is seldom cheap and carries the price of pain, I would recommend waiting a minimum of 6 months before attempting to get a tattoo. The risk factors associated with the side effects of retinoids on the skin far outweigh the benefits of getting a tattoo. The decision to get a tattoo during or right after treatment is completed could result at best that nothing will happen and you'll walk with a new tattoo. At worst, you will have a tattoo that has healed unevenly on skin that has become scared and discolored due to hyperplasia and hypopigmentation. The result would be that you would need to undergo another tattoo session to correct the damaged tattoo, undergoing the pain of both the procedure and the cost and increasing the chance of scarring.

I suggest consulting with your dermatologist before undergoing any form of cosmetic procedure such as tattoos, permanent cosmetics, laser removal, dermabrasion or other skin related procedure.