Complications of Body Art

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

• Advise your patient of the complicationsthat are often associated withtattooing and piercing. Studies haveshown that many persons who opt forbody art are unaware of the potentialhealth risks and sequelae.¹³
• Describe the procedures of tattooingand body piercing to your patient. Heor she may not know that tattooinginvolves multiple intradermal injectionsto achieve the design's color andpattern.
• Emphasize the need for these practicesto be performed in sanitary environmentsby trained personnel(Table 2).¹⁴
• Stress the importance of appropriatewound care and aftercare.Prepare patients for the healingtime needed for their procedure(Table 3). Recommend the followingcare for new tattoos^14,15:
  --Wash tattoos frequently with soapand water and apply antibiotic ointmentfor the first 2 or 3 days. Thereafter,keep the area clean and apply lotionto prevent drying and scabbing.
  --Seek medical evaluation if skinredness or whitish drainage persistsbeyond the first few days.
  --Do not rub or dislodge the scabthat will form and remain for 1 to 2weeks.
  --Do not swim or use saunas orsteam rooms until the area hashealed.
  --Apply sunblock to all exposed skin,including tattoos; sunlight fades thepigments.
• Emphasize the following care forpiercings^14,15:
  --Select high-quality jewelry, such asrings and ornaments made fromsurgical steel, 14-carat gold, niobium,or titanium. Do not use jewelry madeof nickel; a contact dermatitis candevelop.
  --Apply ice for swelling, if necessary.
  --Do not allow pierced areas to comein contact with unclean hair, hands,clothing, or bed linens.
  --Wash area with antibacterial soaptwice daily; rinse well; rotate jewelry;and dry the area thoroughly.
  --Use antiseptic ointment for 1 weekonly; after eating, rinse oral piercingswith mouthwash that does not containalcohol.
  --Do not use alcohol, hydrogen peroxide,or iodine on the wound.
  --Avoid public pools, hot tubs, spas,and the body fluids of others until thepierced area is completely healed.
  --Expect redness and slight dischargefor a few days. Seek medicalevaluation if oozing pus, swelling, orcrusting develops.
• Educate your patient about tattoo removalprocedures. Explain thattoday's fashion statement may bepass tomorrow and while lasersurgery, dermabrasion, or excisioncan be tried, these modalities canbe risky and may not be completelysuccessful.

References:

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Universityof Iowa Health Care; 1998. Available at:http://www.vh.org/Patients/IHB/Derm/Tattoo/index.html. Accessed November 6, 2002.