That depends on what, exactly, you want to accomplish. You can use Gimp or Photoshop, (if you use Gimp, make sure you install the DDS plugin), open up the texture for the skin you wish to add a tattoo to, (i.e. Data\textures\actors\character\male\malebody_1.dds and malehead.dds for males, Data\textures\actors\character\female\femalebody_1.dds and femalehead.dds for females), then copy/paste your tattoo image onto the texture. You should note that every non-beast race female uses the femalebody_1.dds, every non-beast male uses malebody_1.dds, so any change you make to those textures is going to show up on pretty much every character ever. If you're looking to add unique tattoos to a specific NPC, I do have a tutorial written up for that, but it requires the above steps plus using the Creation Kit.