Clinical Review

Health Risks Associated with Tattoos and Body Piercing

Journal of Clinical Outcomes Management. 2014 July;21(7)

Author(s):

References

1. Schmidt R, Armstrong M. Tattooing in adolescents and adults. Up to Date 2013. Available at www.uptodate.com.

2. US Food and Drug Administration. Tattoos and permanent makeup. 2009. Available at www.fda.gov/Cosmetics/ProductandIngredientSafety/ProductInformation/ucm108530.htm.

3. Armstrong ML, Koch JR, Saunders JC, et al. The hole picture: risks, decision making, purpose, regulations, and the future of body piercing. Clin Dermatol 2007;25:398-406.

4. Schorzman CM, Gold MA, Downs JS, Murray PJ. Body art: attitudes and practices regarding body piercing among urban undergraduates. J Am Osteopath Assoc 2007;107:432-8.

5. Urdang, M, Mallek, J, Mallon, W. Tattoos and piercings: a review for the emergency physician. West J Emerg Med 2011;12:393–8.

6. Braverman S. One in five US adults now has a tattoo. New York: Harris Interactive; 2012.

7. Corso RA. Nationwide Harris poll. New York: Harris Interactive; 2008.

8. Laumann AE, Derick AJ. Tattoos and body piercings in the United States: a national data set. J Am Acad Dermatol 2006;55:413–21.

9. Antoszewski B, Sitek A, Fijałkowska M, et al. Tattooing and body piercing--what motivates you to do it? Int J Soc Psychiatry. 2010;56:471–9.

10. Quaranta A, Napoli C, Fasano F, et al. Body piercing and tattoos: a survey on young adults’ knowledge of the risks and practices in body art. BMC Public Health 2011;11:774.

11. Glassy C, Glassy M, Aldasoiuqi A. Tattooing: medical uses and problems. Clev Clin J Med 2012;79:761–70.

12. Sperry K. Tattoos and tattooing. Part II: gross pathology, histopathology, medical complications, and applications. Am J Forensic Med Pathol 1992;13:7–17.

13. Kaur RR, Kirby W, Maibach H. Cutaneous allergic reactions to tattoo ink. J Cosmet Dermatol 2009; 8:295–300.

14. Kennedy BS, Bedard B, Younge M, et al. Outbreak of Mycobacterium chelonae infection associated with tattoo ink. N Engl J Med 2012;367:1020–4.

15. CDC. The hidden dangers of getting inked. Available at http://blogs.cdc.gov/publichealthmatters/2012/08/the-hidden-dangers-of-getting-inked.

16. LeBlanc PM, Hollinger KA, Klontz KC. Tattoo ink-related infections—awareness, diagnosis, reporting, and prevention. N Engl J Med 2012;367:985–7.

17. Shinohara MM, Nguyen J, Gardner J, Rosenbach M, Elenitsas R. The histopathologic spectrum of decorative tattoo complications. J Cutan Pathol 2012;39:1110–8.

18. Reddy KK, Hanke CW, Tierney EP. Malignancy arising within cutaneous tattoos: case of dermatofibrosarcoma protuberans and review of literature. J Drugs Dermatol 2011;10:837–42.

19. Tope WD, Shellock FG. Magnetic resonance imaging and permanent cosmetics (tattoos): survey of complications and adverse events. J Magn Reson Imaging 2002;15:180–4.

20. Holbrook, J, Minocha J, Laumann A. Body piercing: complications and prevention of health risks. Am J Clin Dermatol 2012;13:1–17.

21. Hogan L, Armstrong ML. Body piercing: more than skin deep. Skin therapy letter. Available at www.skintherapyletter.com/2009/14.7/2.html.

22. Raja SG, Shad SK, Dreyfus GD. Body piercing: a rare cause of mitral valve endocarditis. J Heart Valve Dis 2004;13:854.

23. Botchway C, Kuc I. Tongue piercing and associated tooth fracture. J Can Dent Assoc 1998;64:803–5.

24. American Dental Association. Statement on intraoral/perioral piercing and tongue splitting. 2012. Available at www.ada.org/prof/resources/positions/statements/piercing.asp.

25. Stirn A. Body piercing: medical consequences and psychological motivations. Lancet 2003;361:1205–15.

26. Koch R, Roberts AE, Armstrong ML, Owen DC. Body art, deviance, and American college students. Soc Sci J 2010;47:151–61.

27. Gueguen N. Tattoos, piercings, and sexual activity. Social Behav Personality 2012;40:1543–7.

28. Skegg K, Nada-Raja S, Paul C, et al. Body piercing, personality, and sexual behavior. Arch Sex Behav 2007; 36:47–54.

29. Deschesnes M, Fines P, Demers S. Are tattooing and body piercing indicators of risk-taking behaviours among high school students? J Adolesc 2006; 29:379–93.

30. Roberts TA, Ryan SA. Tattooing and high-risk behavior in adolescents. Pediatrics 2002;110:1058–63.

31. Owen DC, Armstrong ML, Koch JR, Roberts AE. College students with body art: well-being or high-risk behavior? J Psychosoc Nurs Ment Health Serv 2013;51:20–8.

32. Claes L, Vandereycken W, Vertommen H. Self-care versus self-harm: piercing, tattooing, and self-injuring in eating disorders. Eur Eat Disord Rev 2004;13:11–18.

33. Hicinbothem J, Gonsalves S, Lester D. Body modification and suicidal behavior. Death Stud 2006; 30:351–63.

34. Stirn A, Hinz A. Tattoos, body piercings, and self-injury: Is there a connection? Psychotherapy Res 2008;18:326–33.

35. Burris K, Kim K. Tattoo removal. Clin Dermatol 2007;25:388–92.

36. American Society for Dermatologic Surgery. Unwanted tattoos. Available at www.asds.net/tattooremovalinformation.aspx.

37. US Food and Drug Administration. Inked and regretful: removing tattoos. 2013. Available at www.fda.gov/ForConsumers/ucm336842.htm.

38. Meltzer DI. Complications of body piercing. Am Fam Physician 2005;72:2029–34.

From the West Virginia University School of Medicine, Morgantown, WV.

Abstract

Objective: To review the health risks associated with tattoos and body piercing.
Methods: Review of the literature.
Results: Tattooing and piercing have become increasingly popular practices in the United States. There are important physical and behavioral risks associated with these forms of body modification. The most common complications from tattooing include skin infections and allergic reactions. Minor complications such as infection and bleeding occur frequently with piercings, but major complications have also been reported. Tattoos and piercings appear to be a marker for risk-taking behavior.
Conclusion: Clinicians should understand the potential complications of these procedures and be able to counsel patients on how to reduce their health risks.

Tattoos and piercings are ancient practices of body modification that have gained widespread acceptance in modern society, particularly among young adults. Tattoos involve the insertion of colored pigment into the dermal layer of the skin with the goal of creating a permanent marking. They are commonly applied using an electrically powered handheld tattoo machine that moves a needle up and down to inject ink through the epidermis and deposit a drop of ink into the dermis [1]. The cells of the dermis are more stable compared with those of the epidermis, so the ink will mostly stay in place for a person’s lifetime [2].

Body piercing is defined as the insertion of a needle or specially designed piercing gun to create a fistula-like opening into either cartilage or skin for the introduction of decorative ornaments [3]. These ornaments can include jewelry, plastic or wood plugs, beads, or pearls. Body piercing has been part of ritualistic or cultural practices for centuries but is rapidly becoming a worldwide mainstream fashion trend, especially among young women aged 17 to 25 years [4]. Ear piercing has become so well accepted that most studies of body piercing do not include earlobe piercing [5].

There are important physical and behavioral risks associated with body modification. In this paper, we review the epidemiology, potential complications, and behavioral factors associated with tattoos and piercings.

Epidemiology

Tattoos are increasingly popular, with a 2012 Harris poll indicating that 1 in 5 adults has at least 1 tattoo [6], up from 14% in 2008 [7]. In the 2012 poll, adults aged 30 to 39 are most likely to have a tattoo (38%) compared to both those younger (30% of those 25–29 and 22% of those 18–24) and older (27% of those 40–49, 11% of those 50–64 and just 5% of those 65 and older). Women are slightly more likely than men, for the first time since this question was first asked, to have a tattoo (23% versus 19% in men). Current US body piercing rates are approximately 36% [3]. Body piercing is more popular among women than in men [8]. Among adolescents, body piercing is performed considerably earlier than tattooing [9]. The head area is the favored location for piercing, while the most common location for a tattoo is the limb [10].