US Pharm. 2013;38(6):33-34.

Body Art

Tattoos and body piercings have become mainstream. One in five American adults has at least one tattoo, and nearly half of all Americans aged 21 to 32 years have at least one tattoo or a pierced body part other than an earlobe. Along with the surge in popularity of body art has come a dramatic increase in the number of tattoo-removal procedures performed annually.

Tattoos and body piercings are not without risk. The primary health problems associated with tattoos are allergic reactions to the ink, skin infections from contaminated ink, bloodborne infections from contaminated equipment, keloid formation, and granulomas around the tattooed skin.

The most common complication of body piercing is infection. Although earlobe piercing carries some risk, ear-cartilage piercing has a much higher risk of serious skin and tissue infection. Another common problem is an allergic reaction to the metal jewelry used, especially if it contains nickel or brass. The piercing of sites such as the lip, cheek, tongue, eyebrow, nose, chin, nipple, navel, and genitals can cause complications specific to the area pierced; for example, adverse effects of oral piercings include broken teeth, gum disease, and swelling of the tongue.

A dermatologist or other health care professional should treat body art–related infections and allergic reactions. These complications also should be reported to the studio where the work was done, as well as the local or state licensing agency that oversees tattoo studios.

Body Art Is Not Without Health Risks

Tattoos and body piercings have become increasingly popular. It is important to be aware of the complications that can result, however.

Tattoos and Their Complications

To create a permanent tattoo, the tattoo artist punctures the top layer of the skin and inserts small drops of ink beneath the surface, usually with a hand-held machine. If the tattooed area is bandaged, the bandage should be removed after 24 hours and an antibiotic ointment applied after the area is cleansed with mild soap and water. A moisturizer may be applied to keep the skin soft. Direct sunlight and swimming should be avoided for several weeks.

The most common complications of permanent tattoos are allergic reactions and infection. Allergic reactions to the ink, such as itching and redness, can occur long after the tattoo is healed. The tattooed skin can become infected, resulting in scarring and ruining the tattoo. Contaminated ink can cause a skin infection. Less commonly, needles contaminated with infected blood can transmit bloodborne diseases such as hepatitis, tetanus, and HIV. Raised scars (keloids) and small, permanently raised bumps (granulomas) may form. MRI imaging can cause the tattooed area to swell because of the metals contained in some inks.

Tattoo removal can be a lengthy, expensive process, and results may be less than ideal. A tattoo may be removed by dermabrasion (“sanding” the skin), laser surgery, or surgically removing the tattooed area and stitching together the surrounding skin. A dermatologist trained in tattoo removal can determine the best procedure based on ink color, skin color, size, and location.

Body Piercing and Its Complications

In body piercing, a hole is made in the skin and decorated with a metal stud or other jewelry. Earlobes are usually pierced using a piercing gun with a sterile, prepackaged earring stud attached. Other areas of the body are pierced with a sterile, hollow needle, and the stud or jewelry is inserted through the hole by hand.

The most common complication of body piercing is infection, which can cause pain, redness, swelling, or discharge in the area pierced. The presence of any of these symptoms requires a prompt visit to a health care professional, who may prescribe an oral or topical antibiotic. Another complication is an allergic reaction (redness, swelling, or itching) to the stud or jewelry.

To prevent infection, the piercing should be performed by a professional body piercer. Proper hand washing, disposable gloves, disposable needles, and sterilized tools should be standard in a reputable piercing shop. Aftercare includes cleansing with soap and water or an antibacterial cleansing solution, with gentle movement of the stud or jewelry to keep it from adhering. Oral piercings require use of an antibacterial mouth rinse.

To prevent allergic reactions, only studs or jewelry made of surgical steel, 14-karat gold, or titanium should be used. Nickel- and brass-containing metals are most likely to cause allergic reactions.

Considerations Regarding Body Art

Any reaction to tattoos or body piercing should be evaluated and treated by a dermatologist or other health care professional. Accurate diagnosis of a skin or tissue infection is important because extended treatment with antibiotics may be necessary.

Body-art procedures should always be performed by a trained tattoo artist or body piercer in a licensed studio that follows local or state health department regulations. Tattoos should be considered permanent because removal may not be completely successful, and the procedure is time-consuming and expensive. Ask your doctor before getting a body piercing or tattoo if you have diabetes, take steroids or blood thinners, or have a chronic disease that suppresses immunity.