Evolving Trends in Tattooing: Patterns, User Attitudes, Cultural Considerations, and Tattoo Characteristics Among Adults in GCC Countries

Background: Tattooing has become increasingly prevalent worldwide; however, data on its epidemiology, knowledge, attitudes, and practices (KAP) in the Gulf Cooperation Council (GCC) region remain limited. Objectives: The aim of this study was to assess the knowledge, attitudes, and practices of tattooing among adults in GCC countries and to characterize tattoo-related features, including pigment colors, anatomical sites, motivations, and associated skin complications. Methods: A descriptive, cross-sectional online survey using convenience and snowball sampling among adults aged ≥18 years residing in GCC countries (Kuwait, Saudi Arabia, Oman, Qatar, Bahrain, United Arab Emirates). Data were collected through a structured, bilingual (Arabic/English) electronic questionnaire using non-probability convenience and snowball sampling. The Chi-square test was used in statistical analysis with SPSS v26 to evaluate the relationship between demographics, anatomical sites, and outcomes, with a significance level of p < 0.05. Results: A total of 9482 individuals participated in the study. The proportion of respondents reporting tattoos was 18.6%, with 48.7% in the 18–23 years age group. The most common anatomical location was the upper extremity (48.6%), with tattoos more frequently located on the left upper limb than the right. Distinct pigment patterns were noted, and the most common colors were green (33.9%) and blue (23.6%), which dominated in the trunk tattoos. The relationship between tattoos on exposed anatomical areas and regret was statistically significant (p < 0.05). The attitudes of the study population towards tattooing were predominantly negative (46.3%), followed by neutral (34.8%); a positive attitude was found only in 18.9%. Of the tattooed individuals, 28.2% obtained tattoos in a professional environment and 61.5% had been tattooed by amateurs. The primary motivations for tattooing included esthetic purposes (41.7%) and personal symbolism (33.5%). Overall, 21.6% of tattooed participants reported skin complications, most commonly allergic reactions (9.8%) and infections (6.7%). Complications were significantly associated with non-professional tattooing and red pigments (p < 0.05). Conclusions: Tattooing in GCC countries demonstrates a moderate proportion with distinct KAP (knowledge, attitudes, and practices) patterns influenced by sociocultural factors. Green pigment color is the most used, followed by blue and black colors. Although there is a comparatively good level of awareness of immediate risks, there are still gaps about long-term complications. The fact that complications are related to unsafe practices highlights the necessity of both targeted public health education and regulations. These findings provide important insights for dermatologists and policymakers in the region.