BODY MODIFICATION: ADOLESCENT PIERCING AND TATTOOING

Body modification has been around for centuries but it is experiencing a new surge of popularity amongst children and teens and the trend has been escalating over the last several years. It is the nature of adolescents to experiment and to be subject to peer pressure as they struggle to discover their true personal identity. While parents and physicians may object for health and other reasons to such procedures, it is incumbent upon them to at least ensure that the least amount of damage is done if adolescents embark on some of these risky discoveries.

What should adolescents be told?

If adolescents are considering piercing their body or having a tattoo they should in the first instance talk to their friends who may have had their body pierced and find out what their experience has been with this procedure. They need to know that they do not have to have their body pierced in order to belong to a group and that if they are uncertain about whether to have their body pierced they should rather wait and weigh up the risks and benefits of the procedures. If they still decide they want to have it done they should be told never to pierce their own body or let a friend do it because of the potential complications.

How does the site selection or body piercing affect the potential complications?

There is no question that body piercing complications vary by body site. The most common sites for piercing are the ear, nose, nipple, navel, tongue, lip and eyebrow. Other sites such as the genitals, chin cleft, knuckles and even the uvula have been used. The navel is a particularly problematic site because it is basically a moist area which endures a great deal of friction from waist bands and clothing. Once a navel infection occurs it may take up to a year to heal. Pierced ear cartilage also heals very slowly and is prone to complications. Interestingly enough, tongue piercing heals very quickly, within 4 weeks, probably because the tongue is such a primitive tissue and because of the potent antiseptic effects of saliva. Other concerns with tongue piercing however include tooth damage from biting on the jewelry, partial paralysis if the jewelry pierces a nerve and extreme inflammation during the first few days.

What infectious complications are seen following body piercing?

Infections may be generalized or localized. Generalized infections usually result from unclean tools of the trade. Foreign materials and germs may be introduce at the time of puncturing of the skin and these include such infectious agents as hepatitis, tetanus, tuberculosis and HIV. Localized infections with pseudomonas aeruginosa or staphylococcus aureus are another major acute problem. These infections can be extremely serious leading to bacteremia, breathing problems, deformity, scarring and all trends of other problems that teenagers do not want or do not expect to happen.

How can infection be avoided?

Before piercing, the body site should be cleaned with an antimicrobial soap such as betadine * Alcohol should not be used at any time as it dries the skin. The piercer should use disposable equipment or steam autoclave all instruments. Several pairs of fresh latex gloves per procedure should be used. Some of these procedures may take a long time and the piercer may scratch his/her head, answer the telephone, pick up a pen, all of which increase the risks for introduction of infectious organisms. A piercing gun should not be used as it cannot be sterilized properly. These guns work by forcibly crushing tissue which could result in the embedment of jewelry in the tissues which may require surgical removal.

What to do if the piercing site becomes infected?

Some piercers recommend leaving the jewelry in place when a local infection occurs. However it is very difficult to bring an infection under control when the offending foreign body remains in place. Ideally the exit hole should be clean and free of jewelry to allow draining and allow abscess formation. A piece of sterile ligature can be used to keep the exit hole open. In general terms, following the body piercing, the pierced site should be cleaned twice a day in order to avoid redness, swelling and a collection of crusty material. Alcohol should not be used at any time. The body site and jewelry should not be fiddled with during the procedure except when cleaning the pierced site.

What jewelry selection should be made in order to avoid infection or an allergic reaction?

Metal allergies are not uncommon when it comes to body piercing. Jewelry used should be smooth and made of surgical stainless steel (316L or 316 LM only), 14K gold, niobium or titanium. Metals that should never be used include goldplated jewelry and nickel.

What problems does tattooing bring?

Like piercing, tattoos are open wounds predisposing to infection. Tattoos must be thoroughly cleaned with an antibacterial soap and water several times a day and should be kept moist with an ointment to prevent scab formation. Allergies are a very potential problem, specifically with red and yellow inks and photosensitivity may occur in some individuals. Carcinoma has rarely been reported at tattoo sites. Teens need to know that for most people a tattoo is a lifelong liability. It should not be embarked upon lightly. Even though new laser techniques are available to remove tattoos, these procedures are painful, time consuming and expensive.

How should physicians and parents deal with body piercing adolescents?

Communication, trust and an open dialogue are necessary at all times in dealing with adolescents whether it be related to the discussion of body art, substance abuse or safe sex. Physicians need to be non-judgmental and serve as listeners not lecturers. A supportive environment must be established if adolescents are to seek piercing and tattooing information and to seek help if any complications do occur.

Why has the trend toward body piercing become so prevalent in the 1990s.

There appears to be no specific reason why this choice of adolescent rebellion should occur at this time. The most recent massive teen rebellion was that of long hair in the 60s. In essence, adolescents are on a path of discovery and separation from their parents as they establish their own identity. Unfortunately body piercing is significantly more dangerous than simply allowing one's hair to grow long but in point of fact men and women in different cultures have pierced their body for many generations and this trend too will likely pass, in time, to be entered into the history books as the symbol as the 90's generation.