Acitretin and Tattoos: What You Need to Know

If you’re taking acitretin for psoriasis or another skin condition and you’re thinking about getting a tattoo, you’re not alone. Many people wonder if it’s safe-especially since acitretin changes how your skin behaves. The short answer: acitretin makes tattooing risky, and most dermatologists strongly advise against it while you’re on the drug-and for years after.

Why Acitretin Changes Your Skin

Acitretin is a retinoid, a type of medication derived from vitamin A. It’s used mainly for severe psoriasis, especially pustular or erythrodermic types, and sometimes for other skin disorders like ichthyosis. It works by slowing down how fast skin cells grow and helping them shed properly. That’s great for flaky, scaly skin-but it also means your skin’s natural repair system gets disrupted.

When you get a tattoo, your skin is essentially wounded. Tiny needles inject ink into the dermis, triggering inflammation and healing. Normally, your body responds by forming scar tissue around the ink particles to keep them in place. With acitretin, that healing process doesn’t work the same way. Studies show that retinoids like acitretin can cause abnormal wound healing, increased scarring, and even keloid formation. In some cases, tattoos done while on acitretin have turned into raised, discolored, or uneven patches that look more like scars than art.

The Waiting Game: How Long After Acitretin Can You Get a Tattoo?

The FDA and major dermatology associations recommend waiting at least two years after stopping acitretin before getting a tattoo. Why so long? Because acitretin stays in your body for a very long time. Unlike isotretinoin (Accutane), which clears in about a month, acitretin can remain detectable in your blood for up to two years-especially if you took high doses or had liver issues.

Even if your psoriasis looks better and your doctor says you’re off the drug, your skin cells are still carrying the memory of the medication. Getting a tattoo too soon increases the risk of:

• Excessive scarring or keloids
• Uneven ink retention-some areas look faded, others blotchy
• Delayed healing that turns into chronic inflammation
• Unpredictable color changes in the tattoo

A 2021 case study published in the Journal of the American Academy of Dermatology followed a patient who got a tattoo six months after stopping acitretin. Within three months, the tattoo developed raised, red, itchy bumps. Biopsy showed granulomatous inflammation-a reaction the doctor linked directly to the drug’s lingering effect on immune cells in the skin.

What About Tattoo Removal?

If you already have a tattoo and are considering acitretin, you might wonder if laser removal is safe. The answer is still no-especially during treatment. Laser tattoo removal works by breaking ink particles into tiny fragments so your immune system can clear them. Acitretin suppresses the skin’s normal immune response in the dermis, which can lead to:

• Poor ink clearance
• Increased risk of blistering and burns
• Permanent textural changes in the skin

Most laser clinics will refuse to treat you if you’re on acitretin. Even after stopping, you should wait the full two years before considering removal. Trying to remove a tattoo too soon can leave you with worse scarring than the original ink.

What If You Got a Tattoo While on Acitretin?

If you already got a tattoo while taking acitretin-or shortly after-you’re not doomed. But you should monitor it closely. Watch for:

• Redness or swelling that doesn’t go away after two weeks
• Raised, firm areas around the ink
• Changes in color or texture over time
• Itching or pain without infection

These could be early signs of abnormal healing. See a dermatologist. They may recommend a skin biopsy to rule out granulomas or other reactions. In some cases, topical steroids or oral medications can help reduce inflammation, but the damage to ink placement is often permanent.

Alternatives to Tattoos While on Acitretin

If you’re eager to express yourself with body art, consider temporary options:

• Henna tattoos (natural, fade in 1-3 weeks)
• Transfer tattoos (stickers that last a few days)
• Body paint or airbrush art for events
• Wearable jewelry or clothing with meaningful designs

These let you enjoy the aesthetic without risking your skin’s health. And when you’re finally clear of acitretin, you’ll have a clean canvas for a real tattoo that lasts.

What Your Dermatologist Should Tell You

Not every doctor brings up tattoos when prescribing acitretin. That’s a gap in patient education. If you’re thinking about body art, bring it up yourself. Ask:

• “When is it safe to get a tattoo after stopping this medication?”
• “Will my skin heal normally once I’m off it?”
• “Are there any signs I should watch for if I already have a tattoo?”

A good dermatologist will give you a written timeline and may even provide a letter confirming your clearance date for tattoo artists. Don’t assume your artist knows about acitretin-they usually don’t. It’s your responsibility to inform them.

Real-Life Consequences

One woman from Manchester got a sleeve tattoo while on acitretin for palmoplantar pustulosis. Two years later, the tattoo’s colors had faded unevenly, and large sections had turned into thick, shiny scars. She spent over £2,000 trying laser removal, which made it worse. Now she says: “I thought the tattoo was worth the risk. I was wrong. I’d rather have plain skin than this mess.”

Another man from Leeds waited three years after stopping acitretin. He got a small chest piece and says it healed perfectly-no issues, no scarring. He credits the wait. “I didn’t rush. I waited until my skin felt normal again. That’s the difference.”

Bottom Line

Acitretin isn’t just a psoriasis treatment-it’s a skin-altering drug with long-lasting effects. Tattoos are permanent wounds. Combining them while you’re on the drug-or too soon after-is asking for trouble. Two years after stopping is the minimum. If you’re unsure, get a blood test to confirm acitretin levels are gone. And never let a tattoo artist talk you into it because they’ve done “a few before.” Most haven’t. Those who have? They’ve seen the bad outcomes too.

Your skin has been through enough. Give it time to heal-not just from psoriasis, but from the medication too. When you’re finally clear, your tattoo will look better, last longer, and won’t turn into a medical headache.