Reluctance determinants of dermatologists about tattooing in patients with psoriasis. An international study

Background: Tattoos are an increasingly common phenomenon, with a prevalence of around 10–30 % of the population in Western countries. The “Tatou” project assessed the risks of tattooing for patients with psoriasis. The first part revealed strong opposition to tattoos in these patients on the part of dermatologists, despite fewer than a quarter of them having any personal experience of complications. The second part showed a very low rate (6.6 %) of local complications on tattoos in these patients as well as absence of severe complications. These observations led us to assess the reasons for reluctance about tattoos in the 468 dermatologists involved in the first part of the “Tatou” project. Patients and methods: We conducted a cross-sectional international study in France, Finland and Italy to evaluate the experience and opinions of dermatologists regarding tattoos in psoriasis patients via an anonymous questionnaire. We then examined the stated reasons for opposition to tattoos in order to establish the profiles of “tattoo-sceptical” dermatologists with regard to 4 different situations: active psoriasis, quiescent psoriasis, treatment with topical steroids and biotherapies. Results: The opinion of dermatologists regarding tattoos was generally unfavourable (3.5 ± 2.8/10), in particular, via multivariate analysis, among older dermatologists (P = 0.01), dermatologists in private practice (P = 0.04), and non-tattooed dermatologists (P < 0.0001). In multivariate analysis, the main parameter affecting the position of practitioner with regard to tattoos was their personal opinion of tattoos (P < 0.0001), regardless of disease activity or type of treatment. Italian, Finnish and female dermatologists exhibited greater reluctance but in a less consistent fashion. Conclusion: This analysis suggests a lack of objectivity among dermatologists opposed to tattoos probably stemming more from a poor opinion of this practice than from any fear of complications in their psoriatic patients.