How to Tell the Difference Between Nummular Eczema and Ringworm
It’s often difficult to distinguish between nummular eczema and ringworm, so it’s always best to be evaluated by a dermatologist, say experts.
Published On: Jul 2, 2021
Last Updated On: May 11, 2022
Getting a tattoo is a big decision for anyone — after all, it stays with you for life. If you live with atopic dermatitis, there are additional factors to consider. We connected with several tattoo artists, a dermatologist and an allergist to get the best recommendations on the pros and cons of body art for people with eczema. We also spoke with members of our eczema community; their stories highlight both the pros and cons of getting tattoos.
There are some clear situations, according to experts, when people with eczema should not get tattooed. If you’re experiencing eczema flare-ups, you should wait. “If there’s any sign of anything wrong with a customer’s skin, that’s an instant ‘no’ for us,” said Lori Rowe, who’s worked for 18 years as a tattoo artist in Portland, Oregon. “Most people are pretty cautious, but sometimes we still have to turn people away.” Flaring skin may indicate a system-wide elevated immune response, even if the location of the prospective tattoo isn’t actively flaring. Dr. Peter Lio, dermatologist at Northwestern University’s Feinberg School of Medicine, echoed Lori’s caution. “I’d probably try to talk someone out of getting a tattoo if they were flaring,” he said. “Even if a person is flaring in a small, distant area, we still consider inflammation as abnormal in the skin as a whole.”
Your skin may appear flare-free where you want to get a tattoo, but, if you’re flaring elsewhere, the ink from the tattoo can still affect your entire body. Dr. Ari Zelig, an allergist based in Miami, Florida, explained that “flaring skin can be worsened by allergens and irritants, especially the dye used in some color tattoo inks.” While black ink is potentially less likely to exacerbate a flare up, Dr. Zelig and Dr. Lio advised patients to wait until their flaring skin had calmed down. If any of the following statements are true for you, according to Dr. Zelig, it means you should not get a tattoo (at least until your status changes):
There are other medical considerations and side effects, too. Dr. Lio said he has treated patients for contact dermatitis caused by their tattoo; he also described treating “a granulomatous reaction” caused by a tattoo “where the body creates a form of chronic inflammation designed to wall off foreign material. It is usually the pigment itself,” he said, “although it can also be bacteria or other contaminants from the tattoo procedure.” Dr. Lio made it clear that both reactions are “extremely difficult to treat, and sometimes the only way out is to surgically excise the tattoo.”
In spite of the risks, people with eczema can and do still get tattoos. Some people with eczema consider getting a tattoo in order to become more self-confident; others describe their desire to make their bodies more beautiful or to create an artistic “mask” that overshadows the eczematous parts of their dermis. Others get tattoos for the same reasons people all over the world get tattoos: they want to capture a story or memory and/or they just like the way they look.
Alexis Smith lives with moderate-to-severe eczema and has had nine different tattoo sessions over the past seven years. “I love having art on my body,” she said. “In my experience, the good has always outweighed the negative.” Jayne Jezebelle is a Baltimore, Maryland-based tattoo artist who has worked with Smith and other customers with dry skin or sensitive skin related to eczema. “I think getting tattoos is a way for people to create a physical identity not determined by their environment or their genetics,” Jayne said. “A lot of my clients have said they felt more at home in their skin, more confident about themselves as they got more tattoos.”
Skyler Winfield lives with moderate-to-severe eczema and got her first tattoo a month after her eighteenth birthday. “Growing up, my eczema was always severe. Kids and adults stared at me and asked what was wrong with me,” she said. “When I finally turned 18, I knew a tattoo was the first thing I wanted to get. It made me more confident knowing that people were staring at the beautiful and thoughtful artwork on my body, admiring it, instead of the eczema on my skin.” Zoe McReynolds expressed the same sentiment. “I have several tattoos in places where my eczema isn’t too bad,” she said. “It’s made a real difference to my self-esteem. If I see a stranger looking closely at me, now I assume they’re checking out my tattoos, rather than staring at my eczema!”
If you’re going to get a tattoo, the next step is choosing the right artist. Ideally, you’ll find a tattoo artist who has experience with eczema or lives with eczema personally. Sarah Walls works as the office manager of Wonderland Tattoos in Portland, Oregon and lives with moderate eczema. She advises her potential clients to “take plenty of time and read all the artist’s reviews. If you look long enough,” she said, “you’ll find an artist who knows about eczema and has worked with customers who have it.”
Before choosing an artist, it’s also important to schedule a consultation. Alexis Smith emphasized the importance of having at least one, or possibly two, in-person conversations with a tattoo artist before getting started. “I explained to my tattoo artist, Jayne, that I have eczema,” Alexis said, “but that it doesn’t typically flare in the areas that I was getting tattooed.” She added that “most reputable shops will make you fill out a medical form and one of the questions is about skin conditions, so they’re very much aware of it.”
Daniel Booey lives with moderate-to-severe eczema and mentioned the importance of researching a tattoo artist’s specific area of expertise; some are experts in illustrations or lettering, or some work only in black and white versus color, and some specialize in working with scarred skin. All the different styles of body art have potential implications for what tattoo might be right for an individual living with eczema; the more research you can do, the more you’ll know about choosing the right type of tattoo for your own body. Consider the importance of tattoo aftercare and how to carefully watch the tattoo site for any potential side-effects or unusual skin reactions.
For people of color with eczema, U.K.-based tattoo artist Samuel Parul-Enahoro emphasized the importance of working with someone who understands the complexities of different skin tones. “When artists aren’t experts in dark skin they can press too hard,” Samuel said. “Always go with somebody more established who understands how to work with different skin tones.” New York City-based tattoo artist Amanda Rodriguez had similar guidance for people of color when considering a tattoo artist. “Send them a clear picture of yourself,” Amanda said. “Once they see your skin tone, they can give you the right advice and send you pictures of their work on skin of color.”
Based on what she’s seen as an office manager in a tattoo shop, Sarah Walls provided the following advice to consider before choosing an artist:
Once you’re ready, be sure to get a small patch test on your skin. “We do patch tests all the time,” said Sarah Walls. “It’s better to know how your skin will respond before we get started.” Dr. Zelig advises his patients to “consider having a small dot tattooed with the desired ink and monitor for a reaction.” Sarah said that a patch test “only takes a few minutes to test out the exact type of needle and ink on a customer’s skin. It’s a good precaution for someone with eczema,” she said. “We could wait a full day, or a full week, whatever’s best for the customer to feel comfortable and confident.” If your skin has a negative reaction, it’s worth discussing your decision, again, with your dermatologist or allergist. The patch test reaction should give a preliminary indication of how your skin will react to the larger artwork and whether it’s medically safe to continue with a full-size tattoo.
Based on our experts’ guidance, the ideal time to get a tattoo is when a person is completely flare-free. Dr. Lio said that “ideally the skin location for a tattoo should be eczema-free for at least a few months: in other words, the eczema should be under excellent control before getting a tattoo.” Artists Lori Rowe and Jayne Jezebelle agreed, and Sarah Walls added several key reminders to consider the night before the appointment:
Sarah said that people with eczema are often better prepared for their own skincare. “I’ve seen people with eczema who take much, much better care of their skin than some of our customers. I know I do,” she said. “In some ways, our customers with eczema already know so much more about how to care for their tattoos than people coming in who don’t know much about their own skin.” This may include bringing in specific soap or lotion or towels that work best for your individual skin: customizing the experience to meet each person’s individual needs, Sarah said, is an important part of the first appointment: “Comfort is everything.”
Members of the eczema community reported a variety of responses to the new tattoo; some had no issues at all, whereas others experienced immediate reactions. Alyssa Elizabeth lives with moderate-to-severe eczema and explained that her “skin got angry all around the tattoo and flared.” She described the healing process as “the worst part of getting a tattoo.” Zoe McReynolds lives with moderate eczema and admitted that her experience getting a tattoo on her back “was a disaster” because the “the ink didn’t settle” and she needed touch up work after it had healed.
Alexis Smith, however, experienced a different challenge. “For some reason my body is able to tolerate a million jabs of a needle,” she said. “But the adhesive from the tape was enough to give me a new flare.” Alexis said that her tattoo artist, Jayne, had alternative “wrap up options” that were more eczema-friendly than the regular tape and Saran wrap that had initially triggered Alexis’s eczema. Planning ahead made the healing process go more smoothly for Alexis’s follow up tattoo work because she knew what to avoid while healing.
Dr. Lio advised people to apply petroleum jelly and a bandage to the tattoo after the procedure. He suggested waiting a full day or so before removing the bandage, whereas Jayne recommended “leaving it on for three days minimum, seven days ideally.” Jayne said that it would be easiest to peel off the bandage “like a sticker by one of the edges” and that it’s “easier to remove under warm running water.” Dr. Lio and Jayne had the same recommendation for a gentle, mild soap for cleaning and either patting the area dry with a paper towel, or ideally, allowing the skin to air-dry. Dr. Zelig gave additional advice for maintenance, including:
After conducting all of your research and talking with the tattoo artist and your doctor, at the end of the day remember that you know your body best. And if you’ve decided to pursue a tattoo (or not), we’d love to hear about your process, advice and recommendations at editor@nationaleczema.org.
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