Primary care providers are seeingan increasing number ofpatients who have snakes orbarbwire coiling around theirarms or gold rings danglingfrom their eyebrows and navels. Tattooingand body piercing are particularlypopular among adolescents andyoung adults-many of whom may notbe aware of the possible medical complicationsof these ancient practices.
Primary care providers are seeingan increasing number ofpatients who have snakes orbarbwire coiling around theirarms or gold rings danglingfrom their eyebrows and navels. Tattooingand body piercing are particularlypopular among adolescents andyoung adults--many of whom may notbe aware of the possible medical complicationsof these ancient practices.PREVALENCE OFBODY ART
Between 10% and 25% of Americansyounger than 26 years have atleast 1 tattoo.1 Recently, we conducteda survey to determine the prevalenceof body art and its complicationsamong students at one university.A questionnaire was completed by454 students (218 men and 236women), or 14.7% of the total enrollment.One hundred six (23%) of therespondents reported having between1 and 3 tattoos.2 The most popularsites were the arms and handsfor men and the back for women.Two hundred twenty-nine (51%)of the respondents had at least 1body piercing. Of the 92 male studentswho had undergone piercing,83 (90%) had pierced ears. Amongthe 137 female students with piercing,the most popular site was the navel(54%), followed by the ear (49%) andtongue (27%). (For reporting purposes,pierced earlobes in women werenot considered pierced ears.) Smallnumbers of both sexes had piercedeyebrows, nipples, and genitalia.HEALTH RISKSTattoos. None of the students inour study who had undergone tattooingreported any complications. However,tattooing is associated with thetransmission of hepatitis B and Cviruses and may be a route for transmissionof HIV.3-5 Body piercing alsohas been implicated in the transmissionof these diseases.6-8In addition to infection, pain,bleeding, and allergic reaction--particularly to the pigments used intattoos--keloids and scarring canoccur (Cases 1 and 2). Keloid responseto skin injury is geneticallydetermined; these scars occurmore frequently in darkly pigmented skin. Keloid formation also maybe associated with piercing (Cases3 through 5).Piercing. About 17% of the studentsin our study with body piercingsreported medical complications(Table 1). Bacterial infection wasthe most common complaint; thenavel was the most frequently affectedsite. No viral infections were reportedin this group. Other complicationsincluded bleeding and localtrauma.Staphylococcus aureus and groupA β-hemolytic streptococci have beenisolated from postpiercing infections.Pseudomonal infection has been reportedfollowing piercing of the auricularcartilage.8Pierced nipples may be contraindicatedfor women with breast implantsand for those who wish tobreast-feed.9,10 Piercings through thepenis and penile urethra--known asPrince Albert rings--have been associatedwith urethral rupture.11Risks that are specific to oralpiercing include gingival recession,gum tissue injury, chipped andcracked teeth, excessive saliva production,and tongue swelling.12Tongue or lip studs that unfastencan become choking hazards. Oralpiercings also may result in alteredspeech and chewing problems.WHAT YOU CAN DO
Armstrong ML, Murphy KP. Tattooing: anotheradolescent risk behavior warranting health education.
Appl Nurs Res
Mayers LB, Judelson DA, Moriarty BW, RundellKW. Prevalence of body art (body piercing andtattooing) in university undergraduates and incidenceof medical complications.
Mayo Clin Proc.
Nishioka SA, Gyorkos TW, Joseph L, et al. Tattooingand risk for transfusion-transmitted diseases: therole of the type, number and design of the tattoos,and the conditions in which they were performed.
Haley RW, Fischer RP. Commercial tattooing as apotentially important source of hepatitis C infection.Clinical epidemiology of 626 consecutive patients unawareof their hepatitis C serologic status. Medicine.2001;80:134-151.
Nishioka SA, Gyorkos TW. Tattoos as risk factorsfor transfusion-transmitted diseases.
Int J InfectDis
MacGregor DM. The risks of ear piercing in children.
Scott Med J.
Guiard-Schmid JB, Picard H, Slama L, et al.Piercing and its infectious complications. A publichealth issue in France [in French].
Tweeten SS, Rickman LS. Infectious complicationsof body piercing.
Clin Infect Dis.
Javaid M, Shibu M. Breast implant infection followingnipple piercing.
Br J Plast Surg.
Martel S, Anderson JE. Decorating the “humancanvas”: body art and your patients.
August 2002. Available at: http://www.contemporarypediatrics.com. Accessed September30, 2002.
Koenig LM, Carnes M. Body piercing: medicalconcerns with cutting edge fashion.
J Gen Intern Med.
American Dental Association. Oral piercing andhealth.
J Am Dent Assoc.
Millner VS, Eichold BH II. Body piercingand tattooing perspectives.
Clin Nurs Res.
Pace University Westchester Counseling ServicesOffice and Personal Development Center.
Back to Basics:For a Healthy Student Body.
Westchester, NY: PaceUniversity; March 2001.
Armstrong ML, Kelly L. Tattooing, body piercing,and branding are on the rise: perspectives for schoolnurses.
J Sch Nurs.
Freyenberger B. Tattooing and body piercing:decision making for teens.
Universityof Iowa Health Care; 1998. Available at:http://www.vh.org/Patients/IHB/Derm/Tattoo/index.html. Accessed November 6, 2002.