Janae Zolna: Body Art Can Leave You With Lasting Medical Complications – September 12, 2011

Monday, September 12, 2011

Body art has been around for thousands of years as part of spiritual rituals, class distinction, and a means of personal expression. Nearly one in seven adults has a tattoo. In addition, 22 percent of 26 to 40 year olds have a piercing other than the earlobes. There are various other forms of body art including branding and scarification, ear gauging, and implanting of plastic and metals under the skin.

Surprisingly, there are no strict regulations on body art practices. Under current California law, businesses are required to register with their county and receive a copy of sterilization and sanitation guidelines. According to Kevin Metcalf with the Humboldt County Division of Environmental Health, a recent survey of the body art businesses in Humboldt County reported compliance with basic health standards. However, there are no sanctioned inspections to confirm this.

Current Senate Bill 300, the Safe Body Art Act, is the California Legislature’s third attempt at regulating the safety of tattoo and body art facilities. If passed, this bill would require specific blood borne pathogen training, sanitation standards, Hepatitis B vaccination for practitioners, client questionnaires, and facility inspections. In addition, this act would regulate body art performed at events and temporary booths.

There is no good data available about complications from tattoos and piercings. Specific risks of tattoos include:

• Allergic reactions, which may occur years after getting a tattoo and are more likely to occur with red dyes.

• Skin infections, where the skin gets red, swollen and painful.

• Skin reactions, such as keloids, where there is an overgrowth of scar tissue.

• Blood borne infections, including Hepatitis B and C, tetanus, and HIV.

Certain conditions, such as lupus and psoriasis, may be triggered by tattooing. Herpes simplex or shingles may be reactivated. Many anesthesiologists refuse to perform spinal epidurals over low back tattoos because of the risk of transmitting the pigment into the spinal fluid. Rarely, tattoo pigments could interfere with the quality of magnetic resonance imaging (MRI) or cause a burning sensation during imaging.

Complications of piercings include infections, allergic reactions, and scar tissue formation. Mild infections are seen in 10 to 20 percent of all piercings, with only a one percent risk of more serious complications.

The risks of complications are related to type and location of the piercing, the experience of the person piercing and the aftercare provided by the customer. Due to the risk of traumatic rips and tears all piercings should be removed during contact sports.

Dental problems such as chipped or broken teeth and gum damage are commonly reported related to tongue barbells, especially after two years or more of duration. The infection rate of tongue piercings is not as high as you would expect with the amount of bacteria in the mouth. Rinsing with oral cleansers such as Listerine may help prevent infections. Oral and nasal piercings can be accidently swallowed or inhaled.

Earrings can become embedded in the ear lobe. People with thicker earlobes are more at risk, especially when using a spring-loaded gun to pierce. High ear piercings, involving the cartilage on the top portion of the ear are more prone to infection because the blood supply is not as good in that area. When high ear piercings do become infected, they are harder to treat and are at risk for causing ear deformities.

Nipple piercings have delayed healing (two to four months) and higher risks for delayed infections. Inflammation and scarring can lead to problems with breastfeeding. Bellybutton piercings can take six to 12 months to heal. Infection rates are high with this location. Navel rings can be problematic as people gain weight or progress to later stages of pregnancy.

Genital piercings are also very slow to heal, up to nine months depending on the site. In men, complications include interrupted urinary flow, the inability to unretract the foreskin, or persistent erection (which can be dangerous). Piercings may also limit the ability to use a condom. Using looser condoms or double condoms can help with this.

There is a risk of infertility in both men and women due to infections that can start at the site of piercing and spread. Instead of improving sexual stimulation, people may end up with numbness or pain.

No formal training is required for tattoo and piercing artists. The quality of standards can vary greatly from one facility to the next. Until stricter regulations are passed, it is up to consumers to protect themselves.

• Examine several studios before deciding on one. Look for a facility that appears clean. Getting body art at a flea market, concert or someone’s house increases risks of infections and complications.

• Don’t be afraid to ask questions about infection control plans. Artists should wash hands and wear new gloves for each procedure. Needles and equipment should be removed from sealed packages. Pigments and containers should also be unused.

• Tattoos and piercings are essentially creating open wounds. Everyone should be given information on what to expect and how to care for the area during healing.

• Using jewelry made of stainless steel, 14K gold, niobium or titanium will reduce the risk of allergic reaction.

• If you have medical issues such as diabetes, conditions which require the use of daily steroids, or congenital heart disease, you should speak with a health provider before considering body art.

• Due to the risk of infection, it is generally recommended that women avoid getting body art during pregnancy.

• Take time to make your decision about body art. Do not make the decision under the influence of drugs or alcohol. Tattoos should be considered permanent as they are often costly and difficult to remove.

• If your tattoo or piercing site is red, swollen, painful, or with foul smelling discharge – you likely have an infection and should seek medical treatment.

Janae Zolna, MD, MPH, is a family physician with Humboldt Open Door Clinic.


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