Body modification risks and safety measures.
If you have a teenager, from time to time you may hear, “It’s my body and I can do what I want!” When it comes to tattoos and piercings, however, in most states your teens cannot legally do what they want without your permission until they’re 18.
Forms of body modification (BM), tattooing and piercing are now regulated by state legislatures. Currently, 45 states have laws prohibiting minors from tattooing their bodies and 38 states have laws prohibiting them from both tattooing and piercing. Some states have gone so far as to impose financial penalties, prison time or both on tattooing and piercing artists. So if your teen is thinking about a BM, after discussing it thoroughly, check your state laws and regulations: www.ncsl.org/research/health/tattooingand- body-piercing.aspx.
There are other laws regarding safety issues and licensing of tattoo and piercing artists. Although the requirements for licensure vary from state to state, at the minimum, licensed certified tattoo and piercing artists must have a minimum of a high school education, and must become certified in blood-borne pathogens, first aid and CPR. To maintain their license, these artists must renew their certifications annually. The Alliance of Professional Tattooists recommends at least a three-year apprenticeship to learn safe, proper techniques. The Association of Professional Piercers website (www.safepiercing.org) includes information on risks and aftercare.
BMs have been around for thousands of years in various cultures worldwide. Changes we make to our bodies not only define us but the culture in which we live. Yet every culture has its own standard for beauty and what is acceptable. Visible BMs are seen as an acknowledgment of sharing common experiences within a group, an expression of personal identity, a silent means of communication or a type of “brotherhood.” This rite of passage from adolescence to adulthood can be a statement defined through distinct fashion trends, tattooing, piercing and other BMs.
In the United States there has been an increase in BMs that began in the 1940s with men in the military and other close-knit groups. In the 1970s ear lobe piercing became a fashion trend for women. Because of this ongoing fashion trend, women tend to be pierced more often than men. Since the 1970s, there has been a steady rise in BMs, especially in the 18-to-50 age-group. It is estimated that 24 percent of the U.S. population has BMs of some sort.
Adolescents who pursue BMs have behavioral characteristics in common, too, especially as the number of BMs becomes greater, larger and more visible. They tend to come from a lower socioeconomic and educational level and participate in risky behaviors such as recreational drug and alcohol use, impulsive decision-making and sensation seeking. But the biggest influence for whether or not to add BMs is dependent upon their friends and other supporting groups. A 2005 survey appearing in the Journal of Adolescent Health found that adolescents between the ages of 12 and 21 perceived BMs as normal within their age-group and minimally risky.
Yet there is a high rate of complications due to piercing and tattooing, ranging from 17 to 69 percent. The risk of complications due to piercing increases depending upon the location of the site, who performs the piercing (the teen, a friend or relative, a licensed piercing artist or not) and how long the site takes to heal. Piercing sites associated with the greatest risks are: nipples, tongues, belly buttons and genitalia. Complete healing may take up to nine months!
Typically complications from piercing are localized bacterial infections, fungal infections, chronic bleeding, further injuries to the site and allergic reactions to jewelry. Serious bacterial complications of piercing include the risk of developing endocarditis, which, left untreated, can lead to heart disease and stroke. Based on these findings, your health care provider should discuss body piercing in the context of providing routine anticipatory guidance to your adolescents and should educate them about safer piercing strategies to help minimize associated health risks.
Complications associated with tattooing are similar to piercing, but they are more permanent. Piercing can always be removed, but tattoos are designed to be permanent in design and color. Medical complications to tattooing are common, especially the formation of keloids, scarring that is raised and textured, and hypersensitivity due to the insertion of dyes and pigments into the skin. The tattooing pigment can cause chronic contact dermatitis, granulomas (nodules under the skin) and psoriasis-like eruptions. Also, any time needles are inserted into the skin there is a great risk of exposure to Hepatitis B and C, viral infections that can destroy the liver. These may be long-term complications, but remember tattoos are applied without any topical analgesic, which means depending on the site, size and amount of detailing tattooing can be an extremely painful procedure.
What about the complications of tattoo removal? If, over time, you decide this symbol of who you are or what you used to be is no longer the image you want to project, how do you remove BMs? Depending on the type of piercing, you can simply remove the jewelry, but some sites may need surgical repair. Tattoos are a different story. Their removal requires a more complex process such as: dermabrasion, surgical excision if the tattoo is small and chemical removal — all of which are painful and cause visible scarring. Although new laser technology has emerged specific to tattooing pigments, it is not completely successful at removing all the evidence of a tattoo and requires multiple treatments. In addition to the cost, risks associated with removal are hyperpigmentation, loss of pigmentation, allergic reactions, scarring and, of course, the inability to remove the tattoos.
If you or your teens are considering BMs, now is the time to start the dialogue. Talk about what is happening in your/ their life, why you/they want them, how our culture may view them now and 20 years from now, the possible risk of infection and disease transmission. Your provider can help you with these difficult conversations and offer guidelines to help you become an informed decision-maker when it comes to safe application, BM care, body sites to consider, the long-term social implications and physical manifestations of BMs, how to recognize complications and, most importantly, when to seek help.
Jan Odiaga, DNP, CPNP, is an Assistant Professor at Rush University, College of Nursing, Chicago. She is also Program Director of the Pediatric Primary Care Nurse Practitioner Program.