Tattoos for people with EDS is a whole topic. Yes, it is.
I discovered this when I set out to write a blog post for the community. I had intended to write one single essay that shared useful information for folks with hEDS, MCAS, and/or POTS. But I know what I already know as a licensed practitioner of Chinese medicine who specializes in EDS and MCAS, so I felt strongly about investigating the constituency about which I do not know. This would be the tattoo artists themselves. As I was sketching out my first draft, I sent an email to twenty-five shops and asked if they were aware of these conditions and if they had any specific protocols for client safety and tattoo success in such cases. I did eventually get about a 30% response rate and the replies were thought-provoking. By that time, though, the one blog post had grown into a two-part series: one for clients and one for tattoo artists.
Most places either had never heard of EDS, MCAS, and/or POTS, or they said they wouldn’t tattoo anyone with these conditions. Three artists replied with substantive commentary. After I had finished blog post one and two, tattoo artist and fellow zebra, Caroline Evans, did find an extra minute in her extremely busy schedule. She replied to my original emailed request for information with substance and care. In response, I could not resist asking her if she’d answer a few questions and allow me to share the interview on this blog.
And so here we are: one essay (“Tattoos When You Have hEDS, MCAS, &/or POTS? (It’s Complicated)“) became two (a companion piece, “EDS, MCAS, & POTS: A Short Guide for Tattoo Artists“), which has now blossomed into three (this interview).
Yes, tattoos for people with EDS and the common add-ons (MCAS and/or POTS) is a whole, entire topic.
Caroline Evans is an interesting woman. I know of her via the show Ink Master and I only know of Ink Master because an episode popped up on my YouTube feed for no apparent reason and I got hooked for a brief period of time. Long enough to find out that a person with hEDS (this would be Caroline) was a contestant, anyway.1 She is a person with multiple chronic conditions, a shop owner, a working tattoo artist, and–as the board secretary for the Alliance of Professional Tattooists (APT)–she is involved in both state and federal developments in her industry. I definitely appreciate that she would take the time to communicate both her professional and her personal insights so that I can share them here.
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When I started preparing for what I thought would be one single blog post, it was a surprise to get either no response or the “we don’t tattoo clients with that/we don’t know what that is” reply. I had assumed that tattoo artists, since they work with skin all day, would be very aware of texture and tone. I assumed that they’d be perceptive regarding soft skin and loose joints. And Caroline did confirm that this can be so, stating that she does know some tattoo artists who are more knowledgeable about EDS than medical doctors she’s dealt with over the course of her own health journey. In other words: IYKYK applies in this context. And for those who do not? In her experience, she says that it is still possible to adjust to a zebra client’s needs during the tattoo process.
Caroline explained, and I quote:
“Like when I have people who are getting light headed, just not taking the tattoo process well, they try to tough it out…don’t let the client do that, you never want anyone passing out, oxygen to the brain is always a good idea, so I usually talk to people as I’m stenciling and starting their tattoo so you get their baseline. If they start not responding as quickly or they start sounding off that may be your only cue that they are starting to brown out. Some people do not give off the physiological signs they are about to pass out, no clammy skin, no paling, not getting cold. As an artist, you should never let it get that far and you suggest a break, lay them flat, give them a cold compress for the back of their neck, give them something cold to drink, maybe sugar. If your client has something weird going on, even if you can’t put your finger on it for any of the hypermobile comorbidities, stop and adjust.”
Self-care during the process is important on both sides of the tattoo machine. Caroline suggests to fellow professionals that, “[G]etting up every hour to give your eyes and body a break is advised” and she minces no words when she reminds that, “[B]eing sedentary and eating like shit equals diabetes, and that’s a tattoo artist’s life, so being intentional with breaks is important. I always tell my clients that I get up every hour but if they need a break before then, let me know. The artist and client need to be comfortable.”
Though she phrases it a little differently than I do with my patients, I am definitely in agreement with her thoughts on the topic of culinary trends and rising rates of hypersensitivity. In her own words: “I’m starting to believe MCAS is from all the processed shit this country believes to be food. I have noticed a significant decline in reactions in myself to triggers when I’m eating clean and in line with an autoimmune diet; when I deviate, I turn into a big-ass hive.”
An aside: If Caroline ever comes to Austin for a tattoo event or a vacation, I hope that she will have time to sit down for lunch and a glass of wine. She totally comes off as an earthy, no-bullshit New Jersey woman and I’ll bet she’s a lot of fun in person!
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I mentioned this in the other two blog posts and it bears repeating here: I have a good number of tattooed patients who had no idea that they had hEDS at the time that they started getting tattoos. Consequently, I asked about this with the questions: “If you could go back to your first tattoos from before you knew and compare them with later tattoos that were acquired after you found out more about HSD/hEDS, what is different? Did your tattoo artists then notice and accommodate your unique skin? Do you go into getting a tattoo now telling the artist (or expecting the artist to know) about HSD/hEDS?”
Caroline’s experience somewhat mirrors what I have heard from some of my tattooed EDS patients in terms of swelling and skin reactions. To wit:
“My tattoos before would swell a lot in the first couple of days after getting them. I actually split my elbow without realizing it. Once I switched to hand lotion, I felt the scab on my elbow and looked in the mirror and it looked like I was cut with a razor. Before going to the integrative doctor, a friend who tattooed my thigh introduced me to CBD oil to help with reducing inflammation. I had voiced my concern about splitting my thigh open from the swelling but [with the CBD oil] in an hour the redness and swelling was gone. After going to the integrative doctor and being put on an autoimmune and anti-inflammatory diet, I do not have any excessive swelling after getting tattooed. I do not have the stretchy skin but I do have the soft velvety sensitive skin and I don’t tell the artists because I haven’t needed to; my skin isn’t sensitive enough and I bring my own bandaging because most shops now are all about those sticky bandages, the derms.”
Her experience with MCAS is a little different than mine, however. Caroline has seen only two cases of anaphylaxis (this she attributes to “the over application of Neosporin and Bacitracin, neither of which are to be used over a large area of broken skin, which is written right on their labels but no one ever reads that”) and I think that this is a great reminder for zebras to ask that the artist double-check pertinent labels before the tattoo starts. She has not seen swollen tattoos (I have, and yes, it is a thing). As to rashes, Caroline suggests attention to product ingredients in those cases, noting that, “I have seen this in people using aftercare products with too many ingredients. I tell them to keep aftercare simple: once a day washing the tattoo and I prefer Dr. Bronner’s baby mild and using either Aquaphor, Aquatat or A&D ointment if they do not have a fish allergy. I’m not sold on these silicone-based ointments, isn’t that a forever chemical?”
I asked her about itchiness or inflammation and a slower-than-expected healing process, and Caroline explained that, “This sounds to me like a red reaction or a light sensitive reaction. To resolve, I was taught to run a dry needle over it and it should settle the tattoo. I believe it’s just triggering the body’s healing process all over again and somehow it gets the body to get it together and get it resolved.”
All of this brings me back to some of the emailed responses that I got–the ones that said they do not tattoo people with EDS, MCAS, and/or POTS. She cautions against potential discrimination charges that can go along with refusing to tattoo based on medical issues, for one thing.2 As a hypermobile person herself, she is pragmatic. Her advice to her professional peers is to say that, “If you as the practitioner have a concern for the tattoo recipient and [a tattoo] being determinantal to their health, ask them to consult with their doctor and get a note.”
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In response to my questions about blow-outs, Caroline explained that, “Blowouts typically occur when the ink is deposited into the skin too far and goes into the fat layer of skin, where there is less uniformity to the cell structures but you can also see that due now due to the newer tattoo inks being ground down so small that even if the tattoo is inserted at the correct level, the particles migrate. I was always taught to start with running my machine lower to see how the skin takes the ink because you can always go back into an unsaturated line but you can’t come back from a blowout. So regardless if the client is hypermobile, you’ll get different skin types reacting to the pigment differently. Age, sun damage, and medications all affect the skin so you start slow.”
So again, and as noted in the other two blog posts, it is truly a matter of communication and taking things slowly. Speaking for myself–and myself only–I still am not convinced that tattoos are worth the risk for people with MCAS.3 But between the many tattooed patients I treat and Caroline’s professional assessment, I am leaning towards the idea that having EDS, per se, doesn’t automatically condemn a person to bad tattoo experiences. Everyone has to decide for themselves, but I do think that sitting down with your doctor or acupuncturist or other medical care provider who knows you is a really smart idea in any case.
I also think that finding EDS-aware tattoo artists is important, and I definitely appreciate how Caroline has shared her knowledge here.
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I wondered, too, how Caroline takes care of herself, so I asked: You operate a tattoo shop, manage your own client base, and are active in the tattoo industry as a representative for your trade organization. As a person with multiple chronic conditions, how do you prioritize self-care and wellness alongside your extremely busy schedule? And…as a person with a complex mix of chronic illness, have you ever tried Chinese medicine?
Her reply, edited for length, demonstrated a person who has had to create her own path. I think that anyone, whether they want a tattoo or not, can benefit from reading this next section. Learning how to take care of yourself with complex chronic illness is a process, and Caroline has been through hers for sure.
She wrote:
“Unapologetically, if a meeting is scheduled when I need to eat, I’ll eat during the meeting. I don’t care, they won’t be feeling the effects of low blood sugar, I will.
I had to make a mental shift to get my physical therapy done every day though. I was like a Victoria Secret Angel doesn’t even need to work out every day but I need to?! A tattoo artist with a shop?! Sure. But if I don’t want pain and dislocations then PT it will be. It was not an easy transition.
Western medicine is so fucked up and actually hurt me more than helped because the system isn’t designed to help and get to a root cause or treat you as a whole. EDS is a full system concern and it affects all systems and all systems work with each other. Western medicine breaks you into body parts. If you don’t find a practitioner in the system that thinks outside the system, you will be gaslighted, blamed for you falling apart, your scoliosis is the root of all your problems, not the underlying genetic hiccup. You’ll get a heel lift from the orthopedic doctor that sees the discrepancy in leg length but will not ask you about your SI joint if it goes out even though they took an x-ray. And [in] two weeks then you’ll finally end up at the physical therapy place that is educating themselves on hypermobility and you’ll be weirded out that they know who Muldowney is and they have their own copy of his book. They’ll actually label you as hypermobile and then fill your at-home tool kit because they know you’re getting kicked off your state assisted health insurance because your LLC made $1,000 too much as a female that isn’t currently pregnant or has kids at home. So, you get a week and a half filled with more help and information then you did from the last physical therapy location you visited on and off for the last 5 years. And off into the unmanageable market place you go but you at least now can assess and reset your SI joint at home.
I have done acupuncture and I get monthly massages (lymphatic ones because deep tissue stiffens me up too much defeating the purpose). My greatest thing I did for myself was go to Dr. Nicole when she was in Belmar NJ. As an integrative doctor at the top of her field, she actually sat with you for an hour and just listened to you. There were so many new modalities and ways of thinking I was introduced to and I have tried to incorporate all that I can at my house since Dr. Nicole has moved to Italy.
I also sat with an occupational therapist, Jordan Signorelli, who was so excited to go into the field because he wanted to help people. Once he graduated and went into the system, he realized it was designed to keep people broken and dependent on the system so he broke away and started teaching master classes to tattoo artists. Our community has high rates of repetitive use damage and he has a history with the industry so he chose to invest in us. I had approached him, saying I didn’t get the normal aches and pains but I was plateauing with my PT and asked if he could help with that. He was up for the challenge and surprised me with the deep dive he did. Part of his protocol was for me to bring back Pilates and start tai chi so I will check out the link you sent. [Note: that would be to Earth Balance Tai Chi, which is owned and operated by Nicola, a woman with EDS].
The self-care is non-negotiable, it happens, and gets incorporated into every day, traveling or at home. It is a lifestyle now. I carry a fanny pack with tissues, hand lotion, Chapstick, and antihistamines. An empty refillable container goes to the airport with me and my PT stuff goes into my carry-on, knowing I’ll be bomb swabbed at the TSA checkpoint for my ankle weights.”
Reading all of this, I felt like I was listening to any one of my own patients. The need to become your own best advocate, the way Caroline absolutely was compelled to develop a self-care practice, how she did so as part of a long, long health journey, and her creativity and determination along the way…all of this resonated. Having EDS–not to mention the usual comorbid conditions–is not for sissies, that’s for sure. And especially for newly-diagnosed zebras, or for people who haven’t quite come to terms what it means to live with complex, chronic illness, I think that Caroline’s description here offers a valuable example of what a person needs to do in terms of self-advocacy and self-care.
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Finding the right team for you can be a challenge. An older blog post of mine, “Referrals: On Finding, Creating, and Nourishing Meaningful Networks (And Why You, The Patient or Client, Should Care About This Subject)” might be useful to you as you put together your team. Another post, also at my main website, Two Hearts Wellness, offers some thoughts on health coaching for people with EDS: “Ehlers-Danlos Syndrome: Resources In Traditional Chinese Medicine And Modern Health Coaching.” As Caroline’s experience demonstrates, it can be extremely helpful to look for support from functional medicine practitioners, occupational therapists, and movement specialists (tai chi can be great for people with EDS, for instance). A health coach can also be a great resource if they know EDS, MCAS, and/or POTS.
I had also wondered what got Caroline into tattooing and her reply to that question is as follows:
“I got involved in tattooing after I attended a convention with my sister and ex-fiancé in 1994. They both wanted to get tattooed and a convention was being advertised on the Rutgers campus so we were all available to go on the Sunday, not knowing that was the short day. My sister diligently went through all the artists portfolios and chose Mike Siderio to do her tattoo, my ex jumped into a chair that was empty and later got that piece covered up. My sister waited patiently all day and then it was time to close the show, Mike felt really bad and offered to tattoo her in their hotel room, where he was staying another night with his wife and young son. We agreed. As my sister was getting tattooed, his son walked up to me and my ex with a marker and asked us if we wanted to draw on him. Combine that with the excitement you could feel on that convention floor, everyone excited about what they were doing and happy to share their knowledge, we were sucked in. I went back to school and submitted a portfolio to the art school.”
Chance and destiny were in her favor, and the artist continues to appreciate the opportunities being a tattoo artist affords her. In her own words, “My favorite part of the community is the community; it is diverse and there is always something to learn.“
And for people with EDS or other complex or mystery conditions, Caroline has strong words of encouragement: “You are your best advocate, no one knows you like you know yourself. That doctor that half listened to you and wrote down nothing of what you said and got offended when you brought up something from Dr. Google can go kick rocks. You live in a body that lets you know the impossible is possible and that there are no limits. That applies to your thinking as well, so there is always a way to better, whatever better looks like to you, feels like to you…just make sure you keep listening to your body. It will guide you to what it needs to be well.”
It’s been quite an adventure, this attempt to figure out just how safe tattoos are for people with EDS, MCAS, and/or POTS. As I mentioned in the first of these three blog posts, I do think that the tattoo industry is due for a reckoning at some point in the relatively near future. With post-COVID syndromes, rising rates of autoimmune disease, and increases in conditions like EDS and MCAS and various manifestations of dysautonomia, questions about safety are set to go well beyond issues like ink content and scope of practice laws. Meantime, on the client side, our experiences with these health conditions require us to do our due diligence in a complementary fashion, otherwise…the consequences may be dire.
But I do think that there is hope for zebras, potsies, and even masties who want to get tattooed.
With excellent communication, through awareness of self and of conditions, and by engaging from a place of integrity, both client and artist can make it possible to create and wear lifelong pieces of art.
Knowledge is power, so make sure you acquire and nurture yours.
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Dr. Paula Bruno, Ph.D., L.Ac., is a licensed acupuncturist and herbalist, an AOBTA-CP traditional Chinese bodywork therapist, an author, and a health coach. She maintains an active and growing practice at Two Hearts Wellness, her Austin, TX office. Dr. Bruno is also available for distance appointments for wellness consultation or coaching.
In her first career, she was a Spanish professor.
Dr. Bruno’s specialties as a Chinese medicine practitioner include: • Musculoskeletal health (acute or chronic pain relief; Ehlers Danlos syndrome & hypermobility support) • Digestive support, gut health, and weight loss • Aesthetic treatment, including scar revision • Men’s health • General preventative care and wellness support for all persons.
She is the author of Chinese Medicine and the Management of Hypermobile Ehlers Danlos Syndrome: A Practitioner’s Guide.
When you are ready to discover what traditional medicine plus a vibrant and engaged approach to holistic health can do for you, either contact Dr. Bruno or book an appointment online.
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Two Hearts Wellness/Holistic Health & hEDS does not accept paid advertising on this website
Note: Material on this web site site is not intended to diagnose, prevent, treat, or cure any disease, illness, or ailment. A Chinese medicine practitioner in Texas identifies syndrome patterns but does not diagnose illness. Material on this web site does not purport to identify syndrome patterns.
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- If I recollect properly, they mentioned it in one of the episodes. I followed up and found “Ink Master Caroline Evans: Living with EDS” and knew that I wanted to contact her for the original blog post in this series. Her shop is Radiant Energy Tattoo in New Jersey and you can see her work at www.MyRadiantEnergy.net and www.TattoosByCaroline.com. You can also find Caroline on Twitter at @tatugirl and on Facebook (facebook.com/caroline.a.evans). ↩︎
- In the tattoo industry, discrimination against people based on medical condition has been an issue in the context of HIV and AIDS. A 2019 article, “Tattoo Studios Are Stopping HIV Positive People From Using Their Services” is a saddening cautionary tale about a potential tattoo client in the UK. “How Much of Your Medical History Should Your Tattoo Artist Know?” is a helpful piece from a safety perspective, though it does not cover the legal considerations of disclosure. “Understanding Tattoo Artists’ Rights: Can Tattoo Artists Refuse to Do a Tattoo?” was written by someone at an insurance company and it clarifies the right to refuse service from their perspective. Ultimately, I think it’s up to a client and their doctor to decide whether or not a tattoo is safe, but I can also see how an artist who doesn’t know EDS, MCAS, and/or POTS would be concerned about safety and (on a pragmatic level) liability. ↩︎
- Definitely check out the MCAS section in “It’s Complicated” for my thoughts and some safety tips. I have had mastie patients whose tattoos swell and itch during flares, even years after the fact, and I have some whose tattoos never flattened out. Everyone has the right to choose what they want to do, but of the three conditions (EDS, MCAS, and POTS), I think that MCAS is the one that has the most possibility for truly bad outcomes. POTS, if you think about it, is probably the least of anyone’s worries because tattoo artists already know how to deal with fainters. And as to EDS…it’s complicated, what can I say? ↩︎
Holistic Health and hEDS 