Review Tattoos in Psychodermatology ˙ Ilknur Kıvanç Altunay 1 , Sibel Mercan 2 and Ezgi Özkur 1, *   Citation: Kıvanç Altunay, ˙ I.; Mercan, S.; Özkur, E. Tattoos in Psychodermatology. Psych 2021, 3, 269–278. https://doi.org/10.3390/ psych3030021 Academic Editors: Jacek C. Szepietowski and Mosad Zineldin Received: 30 May 2021 Accepted: 2 July 2021 Published: 6 July 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Department of Dermatology, University of Health Sciences, ¸ Si¸ sli Etfal Training and Research Hospital, Istanbul 34371, Turkey; ialtunay@gmail.com 2 Department of Psychiatry, Istanbul Gedik University, Istanbul 34876, Turkey; sibelmercan@yahoo.com * Correspondence: ezgierdal@hotmail.com Abstract: Tattooing is a permanent form of body art applied onto the skin with a decorative ink, and it has been practiced from antiquity until today. The number of tattooed people is steadily increasing as tattoos have become popular all over the world, especially in Western countries. Tattoos display distinctive designs and images, from protective totems and tribal symbols to the names of loved or lost persons or strange figures, which are used as a means of self-expression. They are worn on the skin as a lifelong commitment, and everyone has their own reasons to become tattooed, whether they be simply esthetic or a proclamation of group identity. Tattoos are representations of one’s feelings, unconscious conflicts, and inner life onto the skin. The skin plays a major role in this representation and is involved in different ways in this process. This article aims to review the historical and psychoanalytical aspects of tattoos, the reasons for and against tattooing, medical and dermatological implications of the practice, and emotional reflections from a psychodermatological perspective. Keywords: tattoo; psychodermatology; body art; self-identity 1. Introduction Tattooing is a body art in which some symbols, drawings, or lettering are imprinted onto the skin of an individual with a permanent dye or ink. These materials are injected into the skin by a tattooist or tattoo artist. Therefore, the process of tattooing involves three main constituents: the skin of the client, an image or design, and a tattooist. The skin of the client is a canvas, which functions as a painter’s tool. Clients have many objectives, which usually include attracting others, beautifying themselves, identifying themselves as part of a specific group, obtaining a particular social status and fashion sense, and marking a significant event or statement. Thus, a client chooses whatever image or design they want and the tattooist is simply a performer (tattoo artist). These images on the skin may have very different meanings for individuals and reflect various desires, emotions, and states of mind to the outside world. In fact, the skin is the largest—and the only visible—organ of the human body, and it is readily noticed by others. Beyond its physiological functions, the skin is a source of self-esteem, contributes to self-image, and plays a significant role in the socializing process throughout an individual’s life [1]. Thus, there is a relationship between the tattoos on one’s skin and one’s emotions, identity, and sociocultural environment. Finally, the location and importance of tattoos in terms of what they reveal about emotions and psychological states should be taken into consideration in dermatologic settings and medicine. The word “tattoo” was derived from the Tahitian word “tatau” (to mark) and later entered the English language through James Cook’s voyages. The history of tattoos can be traced back to 12,000 B.C. Thus, as with art on cave walls, drawing on and dying the skin are ancient practices as well [2]. Unfortunately, in contrast to art on cave walls, tattoos on bodies cannot continue their existence for so long. The only exception to this is tattoos found on frozen mummies. Ötzi, the Iceman, who was believed to have lived between 3370 and 3100 B.C., had numerous tattoos of simple dots and lines on various parts of his body Psych 2021, 3, 269–278. https://doi.org/10.3390/psych3030021 https://www.mdpi.com/journal/psych