Background <p>The growing number of people with tattoos has sparked interest in the scientific community regarding the potential effects of tattoos on health and physical exercise.</p> Objective <p>To analyze the available scientific evidence on the impact of tattoos on thermoregulation, pain perception, and dermatological health among people who engage in physical exercise.</p> Materials and methods <p>A systematic search was conducted in databases such as PubMed, Web of Science, ScienceDirect, Google Scholar, and SportDiscus, including observational and experimental studies published since 2000.</p> Results <p>Six studies evaluating the effects of tattoos on sweating during exercise were included (n = 116 participants). The evidence was heterogeneous. Only one observational study reported a lower rate of epidermal growth factor excretion in tattooed skin. In contrast, the other studies found no significant differences in sweat rate or electrolyte concentration in sweat between tattooed and non-tattooed skin.</p> Conclusions <p>Current evidence, based on studies involving exercise, is limited and inconclusive regarding a possible effect of tattoos on thermoregulation that could damage sweat glands or cause chronic inflammation. The certainty of this evidence is low, and, essentially, there is a lack of direct data on pain perception and dermatological health during exercise. Further research with greater control and standardization is needed including not only thermoregulation but also pain perception and dermatological health to determine the actual impact of tattoos on health and physical exercise.</p>