SAN FRANCISCO – Body modifications are all the rage, so physicians need to know that troublesome tattoos can interfere with MRIs, and should keep a pair of pliers handy to deal with problematic piercings.
Approximately 36% of Americans aged 25-29 years have one or more tattoos. Piercings are most common among 16- to 20-year-olds, 47% of whom have rings, anchors, studs, or other metallic objects poking through various body parts. Some 10% of Americans aged 12-15 years and 27% of people aged 21-25 years have body piercings, Dr. Rachel L. Chin said at the annual meeting of the American College of Emergency Physicians.
Patients aren’t the only ones favoring the fashion.
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The upper ear cartilage is largely avascular, and thus prone to poor healing and more serious infection from piercing.
"I don’t think I can name a single night nurse who doesn’t have more than one piercing other than in the ear," said Dr. Chin of San Francisco General Hospital and a professor of emergency medicine at the University of California, San Francisco.
Tattoo pigments may contain heavy metals and iron that act as conductors during MRI and can cause a burning sensation and intense pain. Although a 2002 survey of 1,032 patients with tattoos who underwent MRI reported no serious soft-tissue reactions or adverse events, the popularity of tattoos has grown astronomically in the past decade, and there now are many case reports of severe burning associated with tattoos and MRI, Dr. Chin said.
If this happens, apply a cool compress or ice packs, she suggested.
It’s difficult to know what’s in an individual’s tattoo. There are no federal regulations of tattoo pigments or studios that offer tattoos, and international pigment suppliers rarely produce lists of ingredients. Tattoo artists also may mix their own colors, and some use printer’s ink or automobile paint, she said. Most tattoo artists have had no formal training in anatomy, infection control, or universal precautions.
The Red Cross prohibits blood donations from anyone who has gotten a tattoo or piercing in the past 12 months unless the tattoo was applied by a studio certified by the Association of Professional Piercers or the Alliance of Professional Tattooists.
Tattoo recipients may show up with another common problem: infection. One study of 766 college students found that tattoos were associated with infection in 45%, local skin reactions in 39%, and hepatitis in two cases (Clin. Nurs. Res. 1999;8:368-85). Infection with hepatitis B and C, HIV, Pseudomonas, Staphylococcus, tetanus, and syphilis have been associated with tattoos. Tattoos from unlicensed artists were associated with outbreaks of methicillin-resistant S. aureus in Ohio, Kentucky, and Vermont.
Tattoo infections can be deadly. If you see a febrile patient with a recent tattoo and no other source of infection, consider the possibility of infective endocarditis, Dr. Chin said.
Another body modification technique called scarification is legal in some states, and regulations of shops vary by county or city. Customers may be branded using an electrocautery knife or may undergo scarring via a chemical burn, a tattoo gun without ink, or a scalpel to remove the outer layer of skin tissue. The design result relies solely on how well the body scars.
Piercing is a common practice in many cultures. In the United States, it most often involves rings in the earlobes, but rings, posts, rods, and dermal anchors are increasingly frequent in other body parts, including the nose, tongue, eyelid, lips, ear cartilage, nipples, belly, genitals, and more. When pop artist Lady Gaga showed up at the Grammy Awards sporting subdermal implants on her forehead, some fans began copying her.
One survey of 225 adolescents with piercings who were seen at an urban hospital found associated infection in 74%, bleeding in 30%, allergic reactions in 26%, and keloids in 19%, Dr. Chin said.
The upper ear cartilage is largely avascular, and thus prone to poor healing and more serious infection from piercing. In such cases, treat infection for staphylococcus or streptococcus infection (as well as methicillin-resistant S. aureus, if it’s a significant infection in your geographical area), but if the patient doesn’t improve after a few days of treatment, switch to ciprofloxacin and assess for Pseudomonas aeruginosa infection, she advised.
Tongue piercings can chip or fracture teeth and significantly increase the risk for gingival recession requiring gum surgery. Aspiration of tongue piercings have been reported during contact sports. Tongue piercings also have been associated with blood-borne infections (such as hepatitis and HIV), endocarditis, significant blood loss, and lingering pain, including trigeminal neuralgia.