Infected Tattoo Signs: Normal Healing vs. Infection

Infected tattoo signs include redness that darkens or spreads, pain that continues or worsens, pus, open sores, and fever or chills, according to the American Academy of Dermatology (AAD). Normal healing can also involve redness, swelling and soreness, so the difference is direction: healing skin gradually settles down, while infected skin gets worse.

This guide explains how to tell the two apart, how an infection differs from an ink allergy, what to tell your doctor and your artist, and where to report a problem in Washington. If you have signs of infection right now, the AAD's advice is to see a doctor or board-certified dermatologist right away. Everything else can wait.

How do you tell normal healing from an infection?

Watch which way the symptoms are heading. The AAD says it's normal for a new tattoo to be red, swollen and sore, to ooze clear fluid, and later to itch, flake and scab. With an infection, the skin reacts differently: redness darkens or spreads instead of fading, and pain continues or worsens instead of easing.

Timing helps too. Susan Massick, MD, a dermatologist at Ohio State Wexner Medical Center, says mild redness is expected for the first two to three days after a tattoo. If redness progresses, worsens or accelerates three to five days afterward, she says, act on it, because a skin infection is likely.

Infections don't always show up in the first week. The AAD says an infection can develop immediately after a tattoo or days to months later, so a tattoo that seemed to heal well can still need a doctor's attention.

For routine care while a tattoo heals, see our tattoo aftercare guide.

When is a tattoo infection an emergency?

Some symptoms need care immediately. Ohio State Wexner Medical Center lists these:

• Severe pain
• Intense swelling
• Severe redness or warmth at the tattoo site
• Fever and chills
• Nausea and vomiting
• Foul-smelling drainage from the tattoo

The FDA adds that more aggressive infections may cause high fever, shaking, chills and sweats. Treating them might take a variety of antibiotics, possibly for months, or even hospitalization or surgery.

You don't need a severe symptom to justify an appointment. The AAD's advice covers any sign of infection: see your doctor or a board-certified dermatologist right away, because the sooner treatment starts, the less damage an infection can do to your health and your tattoo.

Could it be an ink allergy instead?

Yes. A rash or bumps can be an allergic reaction to the ink rather than an infection. According to the AAD, most people who react are allergic to one specific color of ink. Red is often the culprit, but any color can cause a reaction. Signs that stay within one color include:

• Redness, swelling and itching
• Small pimple-like bumps, raised scaly patches or deep lumps
• Blisters
• Skin that crusts or flakes off
• Watery fluid leaking from the area

An allergy can start immediately, weeks or years later, or even decades afterward. The AAD notes that some people first react after a medical treatment, such as starting antiretroviral treatment for HIV or having joint-replacement surgery. For a serious reaction, it says to seek immediate medical care.

The two can look alike. The AAD also lists itchy, red, painful bumps as a sign of infection, so let a dermatologist make the call. Before the appointment, note which colors are affected and when the change started.

What do Washington cases show about tattoo infections?

Washington has its own documented example. A 2012 CDC report described tattoo-associated nontuberculous mycobacterial (NTM) skin infections in four states. In Washington, clinicians reported the first two cases to local public health authorities, and an investigation by Public Health – Seattle & King County identified five confirmed and 26 possible cases.

The Washington cases fell into two clusters. One had three confirmed Mycobacterium abscessus cases and 24 possible cases in people tattooed with black ink from one ink company. The other had two confirmed M. chelonae cases and two possible cases linked to another company's gray ink.

Three points from that report matter for anyone with a new tattoo:

• What it can look like. NTM infections range from mild inflammation, such as a rash, papules or nodules, to severe abscesses. The CDC advised physicians to consider NTM when persistent papular rashes or nodules appear in newly tattooed areas.
• How long treatment can take. NTM infections can require at least four months of treatment with a combination of two or more antibiotics.
• What to do. The CDC advised people to be aware of the potential for infection after tattooing and to seek medical advice if persistent skin problems occur.

The report also told tattoo artists to avoid diluting ink and, if dilution is needed, to use only sterile water. The FDA makes a related point: using non-sterile water to dilute pigments is a common cause of contaminated ink, and an ink can be contaminated even if the container is sealed or the label says the product is sterile. Between 2003 and 2024, firms conducted 18 voluntary recalls of tattoo inks contaminated with microorganisms, according to the FDA's announcement of its final guidance for ink makers in October 2024.

A 2012 investigation doesn't measure how likely an infection is today. It does show why ink details matter when you report a problem.

What should you tell your doctor and ask your artist?

Start with the doctor, then the artist.

For the appointment, write down:

• The date of your tattoo, and when each symptom started
• How the redness, pain or drainage has changed since then
• Whether only one ink color is affected
• Any fever, chills, nausea or vomiting

From the artist, ask for the brand, color and any lot or batch number of the ink or diluent used. The FDA recommends this so the artist can identify the ink and avoid using it again, and so the source of the problem and how to treat it can be worked out. Getting those details shouldn't delay your appointment.

Licensed Washington shops follow state sterilization and record-keeping rules. Our Washington tattoo laws guide explains what those rules require and how to check an artist's license.

Where do you report a tattoo problem in Washington?

Get medical care first. Then pick the route that fits the problem:

Washington State Department of Licensing

DOL's complaint page lists "Tattoos, body piercing, and body art" among the professions you can file against, and it accepts reports of unlicensed activity. You can file online, email the complaint form and documents to [email protected], or mail them to the Centralized Investigations and Audits Unit, PO Box 1098, Olympia, WA 98507-1098.

The complaint must include copies of all related documents and a detailed explanation, in the order events occurred, with dates, the other people involved and what you've already tried to resolve the problem. Our laws guide covers what DOL can and can't do once it receives a complaint.

FDA

The FDA's reporting page lists tattoo ink among cosmetic products and gives three ways to report a reaction:

• The MedWatch online voluntary reporting form, which the FDA strongly encourages
• Form FDA 3500B, sent by mail or by fax to 800-332-0178
• The Food and Cosmetics Information Center at 1-888-723-3366, option 4

The FDA wants reports whether or not the reaction needed medical treatment. Include as much detail as you can about the ink, your reaction and its outcome.

Local public health

If you think several people were infected after the same shop or ink, tell your doctor. In the 2011–2012 Washington investigation, it was clinicians' reports to local public health that brought the cases to light. In Seattle and King County, Public Health – Seattle & King County lists 206-296-4774 for its Communicable Diseases Epidemiology and Immunization Section, and the county says its communicable disease surveillance includes reports from healthcare providers, laboratories and the public. Elsewhere in Washington, the Department of Health's directory of local health jurisdictions links to each local health department.

How can you lower the risk with your next tattoo?

Much of the risk comes down to technique and ink, and you can ask about both before you book. Ohio State Wexner Medical Center calls unsterile technique "a top culprit." It says artists should sterilize equipment with a working autoclave, always use new, sterile needles, wash their hands often, wear gloves, disinfect between clients, avoid cross-contaminating ink between clients, and use clean, sterile water when diluting ink. The most common tattoo infections are bacterial, such as from Staphylococcus, it adds, and in rare cases unsterilized equipment and reused needles can lead to serious viral infections, including HIV, hepatitis B and hepatitis C.

A few practical steps follow from that:

• Check the license. Our Washington tattoo laws guide shows how to look up an artist and a shop in DOL's License Lookup.
• Ask about dilution. Ask whether the artist dilutes ink and, if so, with what. The CDC and the FDA both point to non-sterile water as a source of contamination.
• Skip DIY kits. The FDA says inks and kits sold as "do-it-yourself" have been associated with infections and allergic reactions.
• Follow the aftercare. Ohio State says the first few days after a tattoo are critical and that you should get clear wound-care instructions and follow them carefully.

What should you do next?

1. See a doctor or dermatologist if you notice any infection warning sign, and get immediate care for severe symptoms.
2. Write down the timeline of your symptoms and which ink colors are affected.
3. Ask your artist for the ink details: brand, color and lot or batch number.
4. Report it: to the FDA for an ink reaction, and to DOL for unlicensed or unsafe tattooing.

If you're planning another tattoo, our first tattoo guide covers how to find an artist and what to ask before you book.