Complications of Body Art
Complications of Body Art
Primary care providers are seeing
an increasing number of
patients who have snakes or
barbwire coiling around their
arms or gold rings dangling
from their eyebrows and navels. Tattooing
and body piercing are particularly
popular among adolescents and
young adults--many of whom may not
be aware of the possible medical complications
of these ancient practices.
Between 10% and 25% of Americans younger than 26 years have at least 1 tattoo.1 Recently, we conducted a survey to determine the prevalence of body art and its complications among students at one university. A questionnaire was completed by 454 students (218 men and 236 women), or 14.7% of the total enrollment. One hundred six (23%) of the respondents reported having between 1 and 3 tattoos.2 The most popular sites were the arms and hands for men and the back for women. Two hundred twenty-nine (51%) of the respondents had at least 1 body piercing. Of the 92 male students who had undergone piercing, 83 (90%) had pierced ears. Among the 137 female students with piercing, the most popular site was the navel (54%), followed by the ear (49%) and tongue (27%). (For reporting purposes, pierced earlobes in women were not considered pierced ears.) Small numbers of both sexes had pierced eyebrows, nipples, and genitalia. HEALTH RISKS
Tattoos. None of the students in our study who had undergone tattooing reported any complications. However, tattooing is associated with the transmission of hepatitis B and C viruses and may be a route for transmission of HIV.3-5 Body piercing also has been implicated in the transmission of these diseases.6-8 In addition to infection, pain, bleeding, and allergic reaction-- particularly to the pigments used in tattoos--keloids and scarring can occur (Cases 1 and 2). Keloid response to skin injury is genetically determined; these scars occur more frequently in darkly pigment ed skin. Keloid formation also may be associated with piercing (Cases 3 through 5). Piercing. About 17% of the students in our study with body piercings reported medical complications (Table 1). Bacterial infection was the most common complaint; the navel was the most frequently affected site. No viral infections were reported in this group. Other complications included bleeding and local trauma. Staphylococcus aureus and group A β-hemolytic streptococci have been isolated from postpiercing infections. Pseudomonal infection has been reported following piercing of the auricular cartilage.8 Pierced nipples may be contraindicated for women with breast implants and for those who wish to breast-feed.9,10 Piercings through the penis and penile urethra--known as Prince Albert rings--have been associated with urethral rupture.11 Risks that are specific to oral piercing include gingival recession, gum tissue injury, chipped and cracked teeth, excessive saliva production, and tongue swelling.12 Tongue or lip studs that unfasten can become choking hazards. Oral piercings also may result in altered speech and chewing problems. WHAT YOU CAN DO
- Advise your patient of the complications that are often associated with tattooing and piercing. Studies have shown that many persons who opt for body art are unaware of the potential health risks and sequelae.13
- Describe the procedures of tattooing and body piercing to your patient. He or she may not know that tattooing involves multiple intradermal injections to achieve the design's color and pattern.
- Emphasize the need for these practices to be performed in sanitary environments by trained personnel (Table 2).14
- Stress the importance of appropriate
wound care and aftercare.
Prepare patients for the healing
time needed for their procedure
(Table 3). Recommend the following
care for new tattoos14,15:
--Wash tattoos frequently with soap and water and apply antibiotic ointment for the first 2 or 3 days. Thereafter, keep the area clean and apply lotion to prevent drying and scabbing.
--Seek medical evaluation if skin redness or whitish drainage persists beyond the first few days.
--Do not rub or dislodge the scab that will form and remain for 1 to 2 weeks.
--Do not swim or use saunas or steam rooms until the area has healed.
--Apply sunblock to all exposed skin, including tattoos; sunlight fades the pigments.
- Emphasize the following care for
--Select high-quality jewelry, such as rings and ornaments made from surgical steel, 14-carat gold, niobium, or titanium. Do not use jewelry made of nickel; a contact dermatitis can develop.
--Apply ice for swelling, if necessary.
--Do not allow pierced areas to come in contact with unclean hair, hands, clothing, or bed linens.
--Wash area with antibacterial soap twice daily; rinse well; rotate jewelry; and dry the area thoroughly.
--Use antiseptic ointment for 1 week only; after eating, rinse oral piercings with mouthwash that does not contain alcohol.
--Do not use alcohol, hydrogen peroxide, or iodine on the wound.
--Avoid public pools, hot tubs, spas, and the body fluids of others until the pierced area is completely healed.
--Expect redness and slight discharge for a few days. Seek medical evaluation if oozing pus, swelling, or crusting develops.
- Educate your patient about tattoo removal procedures. Explain that today's fashion statement may be pass tomorrow and while laser surgery, dermabrasion, or excision can be tried, these modalities can be risky and may not be completely successful.
1. Armstrong ML, Murphy KP. Tattooing: another adolescent risk behavior warranting health education. Appl Nurs Res. 1997;10:181-189.
2. Mayers LB, Judelson DA, Moriarty BW, Rundell KW. Prevalence of body art (body piercing and tattooing) in university undergraduates and incidence of medical complications. Mayo Clin Proc. 2002;77:29-34. 3. Nishioka SA, Gyorkos TW, Joseph L, et al. Tattooing and risk for transfusion-transmitted diseases: the role of the type, number and design of the tattoos, and the conditions in which they were performed. Epidemiol Infect. 2002;128:63-71.
4. Haley RW, Fischer RP. Commercial tattooing as a potentially important source of hepatitis C infection. Clinical epidemiology of 626 consecutive patients unaware of their hepatitis C serologic status. Medicine. 2001;80:134-151.
5. Nishioka SA, Gyorkos TW. Tattoos as risk factors for transfusion-transmitted diseases. Int J Infect Dis. 2001;5:27-34.
6. MacGregor DM. The risks of ear piercing in children. Scott Med J. 2001;46:9-10.
7. Guiard-Schmid JB, Picard H, Slama L, et al. Piercing and its infectious complications. A public health issue in France [in French]. Presse Med. 2000;29:1948-1956.
8. Tweeten SS, Rickman LS. Infectious complications of body piercing. Clin Infect Dis. 1998;26:735-740.
9. Javaid M, Shibu M. Breast implant infection following nipple piercing. Br J Plast Surg.1999;52:676-677.
10. Martel S, Anderson JE. Decorating the “human canvas”: body art and your patients. Contemp Pediatr. August 2002. Available at: http://www. contemporarypediatrics.com. Accessed September 30, 2002.
11. Koenig LM, Carnes M. Body piercing: medical concerns with cutting edge fashion. J Gen Intern Med. 1999;14:379.
12. American Dental Association. Oral piercing and health. J Am Dent Assoc. 2001;132:127.
13. Millner VS, Eichold BH II. Body piercing and tattooing perspectives. Clin Nurs Res. 2001;10: 424-441.
14. Pace University Westchester Counseling Services Office and Personal Development Center. Back to Basics: For a Healthy Student Body. Westchester, NY: Pace University; March 2001.
15. Armstrong ML, Kelly L. Tattooing, body piercing, and branding are on the rise: perspectives for school nurses. J Sch Nurs. 2001;17:12-24.
16. Freyenberger B. Tattooing and body piercing: decision making for teens. Virtual Hospital. University of Iowa Health Care; 1998. Available at: http://www.vh.org/Patients/IHB/Derm/Tattoo/ index.html. Accessed November 6, 2002.