Dermatology: Practical and Conceptual


Letter to the Editor | Dermatol Pract Concept. 2025;15(1):4990 1

Sparing Phenomenon in Tattoos:  
An Underestimated Phenomenon

Nicolas Kluger1,2

1 Department of Dermatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

2 “Tattoos Consultation Unit”, Department of Dermatology, Hôpital Bichat - Claude Bernard, Paris, France

Citation: Kluger N. Sparing phenomenon in tattoos: an underestimated phenomenon. Dermatol Pract Concept. 2025;15(1):4990.  
DOI: https://doi.org/10.5826/dpc.1501a4990

Accepted: September 9, 2024; Published: January 2025

Copyright: ©2024 Kluger. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 
License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and 
reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Nicolas Kluger, MD, PhD, Department of dermatology, Helsinki University Hospital, Meilahdentie 2, 00250 
Helsinki, Finland. E-mail: nicolas.kluger@hus.fi.

Dear Editor,

I read with great interest the recent article by Bojahr et al  

published in the Journal about a patient that experienced 

sparing phenomenon, reverse Koebner type, as chronic urti-

caria spared tattooed areas [1]. As the authors acknowledged, 

sparing phenomenon is non-specific from a skin condition 

and is not restricted to psoriasis or urticaria. The frequency of 

this phenomenon is unknown but could be underestimated. 

It may go unnoticed for the patient if the phenomenon is too 

mild to be noticed: small tattoos, low number of tattoos, lack 

of extensive rash, lack of symmetry of the rash, and lack of 

notable impact on patient quality of life. Additionally, physi-

cians may simply overlook it due to lack of interest to search 

specifically for this phenomenon in a tattooed patient.

As a dermatologist with specific interest in tattoos and 

tattoo-associated health issues, I tend to observe with care 

the tattooed skin of my patients. In my own experience, both 

in France or in Finland, I have seen patients disclosing sparing 

phenomenon with various conditions, such as psoriasis  

(N = 2 patients), including 1 that was previously reported [2],  

atopic dermatitis (N = 2), maculopapular exanthema  

(N = 2), including 1 case figure published elsewhere [3], cu-

taneous vasculitis (N = 2), and cutaneous vasculopathy in 

hepatitis C (N = 1). As showed by Spyridonos et al, it may be 

difficult to notice a clear difference with the naked eye, and 

automated mathematic tools may be of help [4]. There is also 

sometimes a thin line between a mild sparing phenomenon 

and the eye of faith of the observer. Acknowledging these 

limitations, sparing phenomenon in tattoos exists and shows 

that tattoos are not fully inert in the skin. The cause of this 

local anergy is unknown but for psoriasis, and it has been 

well known since the work by Eyre and Kruegger [5].  Future 

studies should evaluate the prevalence of skin diseases in 

heavily tattooed individuals that display tattoos from head 

to toe. I would not yet recommend that patients get tattooed 

only to induce remission of the disease.



2 Letter to the Editor | Dermatol Pract Concept. 2025;15(1):4990

on… has the time come for simplification?]. Ann Dermatol Vene-

reol. 2018;145(5):347-53. DOI: 10.1016/j.annder.2018.02.006. 

PMID: 29673749.

4. Spyridonos P, Zampeli V, Rapti SN, Bassukas ID. A Gut-

tate Psoriasis That Tends to Spare Three Tattoos: A Macro-

phage Liaison. Case Rep Dermatol Med. 2021;2021:9448636.  

DOI: 10.1155/2021/9448636. PMID: 34552797. PMCID: PMC 

8452437.

5. Eyre RW, Krueger GG. Response to injury of skin involved and 

uninvolved with psoriasis, and its relation to disease activity:  

Koebner and ‘reverse’ Koebner reactions. Br J Dermatol. 

1982;106(2):153-9. DOI: 10.1111/j.1365-2133.1982.tb00924.x.  

PMID: 7037041.

References

1. Bojahr K, Sztramska A, Zysk W, Rolewicz A, Romantowski J, 

Chełmińska M. Does a Tattoo Protect Against Chronic Sponta-

neous Urticaria? An Unusual Finding. Dermatol Pract Concept. 

2024;14(3):e2024172. DOI: 10.5826/dpc.1403a172. PMID: 

39122532. PMCID: PMC11314273.

2. Kluger N, Jegou MH. Psoriasis et phénomène de Koebner 

 inversé après tatouage [Psoriasis and reverse Koebner response 

after tattooing]. Ann Dermatol Venereol. 2018;145(1):48-9.  

DOI: 10.1016/j.annder.2017.01.005. PMID: 28237534.

3. Kluger N. Phénomènes de Köbner, Renbök, Wolf et Cie… est-il 

temps de simplifier ? [Köbner, Renbök, Wolf phenomena and so