ARTICLE
Auteur(s) : Boguslaw
Antoszewski1, Aneta Sitek2, Marta
Jędrzejczak1, Anna Kasielska1, Julia
Kruk-Jeromin1
1Plastic Surgery Clinic, University Hospital No 1,
Kopcińskiego 22, 90-153 Lodz
2Chair of Anthropology, Banacha 12/16 90-237 Lodz
accepté le 7 Juin 2006
Body piercing and tattooing have been popular and known practices
of body ornamentation almost all over the world since time
immemorial. Piercing and tattoos are promoted by fashion and the
media and are becoming more and more popular, especially among
young people. Within the past 30 years those procedures have become
quite common in America and Western Europe [1, 2]. Nowadays body
piercing is believed to involve from 8% to 50% of the population,
while tattooing involves from 3% to 25% [3-6]. Recently this
fashion has also reached Poland and it is impossible not to notice
the intensity of this trend. Taking into consideration the way body
piercing and tattoos are performed it is easy to see potential
risks and the complications that can follow these
procedures.According to the medical literature possible
complications after body piercing and tattooing are very similar.
The most common are: bleeding, bacterial or viral infections
(mainly viral hepatitis, HIV), mechanical tissue tearing, allergies
and also systemic infections like endocarditis or sepsis [6-13].
Additionally, body piercing can be accompanied by: hypertrophied or
keloid scars, impairment or palsy of cranial nerves (for example,
the facial nerve, trigeminal nerve, hypoglossal nerve,
glossopharyngeal nerve), chonditis or even bowel obstruction [6,
14-16]. Piercings in less common places like the genitals or
nipples can cause disruption and/or stenosis of the urethra,
inflammation of the pelvis or nipple infection [6, 17, 18].
Characteristic complications after tattooing mainly involve the
skin. The most common are: skin inflammation and/or its necrosis,
development of pseudolymphoma, photophobia and also gradual
assimilation of the pigment in macrophages, which transport it to
the regional lymph nodes [19-21].Dangerous complications as
mentioned above force the medical society to take a greater
interest in these problems and set standards for education and
hygiene in the establishments which perform the procedures of body
piercing and tattoos. It is worth remembering that body
ornamentation procedures should not be done in body areas with skin
lesions (e.g. moles, scars) and not in pregnant women or children
under 18 years of age.The aim of this research was to compare the
frequency of complications after body piercing and tattooing and to
analyze the conditions under which the procedures were performed.
Material and methods
The questionnaire studies were carried out by doctors in youth
clubs and pubs in Lodz on people with piercing or tattoos who
consented to answer the questionnaire. The data were collected on a
group of 824 people (57.8% were females and 42.2% males) of whom
408 had piercing and 416 permanent tattoos. The population included
school children – 512 people (62.1%), students – 135 (16.4%) and
177 persons over 23 years old (21.5%). The subjects mainly came
from Lodz, in single cases from other towns. The subjects’ ages at
the time of the study ranged from 14 to 52 (the mean 24.2; standard
deviation 6.5). The procedures of body piercing were performed from
6 months to 11 years and tattoos from one to 35 years prior to the
questionnaire study.
All the people questioned answered the questions related to
their sex, age at examination, age at performing piercing or
tattooing, pierced or tattooed body area, establishments where the
procedure was done, professionalism of the people performing it and
possible complications.
The data were compared by using the fraction difference
statistic test.
Results
The analysis of questionnaire data has demonstrated that at the
time of decision-taking and undergoing body piercing the subjects
were from 14 to 25 years of age, whereas in the case of tattoos
they were from 13 to 44 years of age.
The subjects usually had the auricles (ear lobe) (40.4%), tongue
(22.3%), navel (16.7%), eyebrows (11.05%), nose (7.35%) and lower
lip (2.2%) pierced. Tattoos were mainly located on the arms
(63.5%), shins (27%) or back (27%) (figures 1 and 2). The
people questioned had from one to 21 tattoos. Most of them (60.6%)
had only one tattoo, 25.9% two or three and 13.5% had four or
more.
Almost eighty-six percent (85.9%) of people questioned (93.1%
with piercings and 78.8% with tattoos) had had the procedure done
professionally- in a doctor’s surgery, beauty parlor or in tattoo
studio. The rest of them had it done by unqualified people at home,
prison or in the army (figures 3 and 4). The frequency of
piercing and tattooing carried out in professional establishments
is statistically different (p < 0.05). Piercing, more often than
tattooing, was done in special establishments by qualified
people.
Complications were noted by 38.35% of people questioned. Among
people with piercing this percentage (45.6%) was statistically
higher (p < 0.05) than in people with tattoos (31.25%). The
people questioned who underwent the procedure of body piercing
noted bacterial infections, which required dermatological treatment
(25.5%), bleeding (12.26%) and tissue tearing (5.88%)
(figures 5 and 7). In 1.96% of the people questioned,
hypertrophied scars developed, and in one case they were localized
in two places- auricle and lower lip ( (figure 6) ). People with
tattoos mentioned local pruritus (21.63%), slight bleeding (7.7%)
or both (1.92%), with no other symptoms ( (figure 7) ). Those
complications did not need medical attention.
Among people questioned with piercing, up to 90.2% definitely
declared their willingness to undergo additional body piercing in
the future, while 9.8% did not exclude such a possibility. In the
group of people with tattoos fewer of them (49.5%) were planning
additional tattoos in the future.
Discussion
The popularity of body piercing and tattooing is increasing around
the world. Many health risks that can result from this kind of body
ornamentation are described in medical articles, in which we can
read about complications either after body piercing or tattooing
[4, 6, 7, 10-12, 14, 15, 17, 18, 20-22]. However, there are only a
few reports which make a comparison between the complications after
body piercing and tattooing [8, 23].
The results obtained in our research have revealed that there is
a big difference with regard to age, at which the questionnaired
people underwent tattoo procedure (13-44 years) and body piercing
procedure (14-25 years). They clearly suggest that body piercing is
more popular among teenagers and young people.
The research carried out by Mayers et al. in a group of 481
students (51% of them had piercing and 23% tattoos) revealed that
17% of examined people mentioned complications after body piercing,
while complications after tattoos were not reported [23]. Our own
material, on the other hand, points to a bigger percentage of
complications after body piercing (45.6%) and the occurrence of
complications after tattooing (31.25%). This difference can result
from the younger age of the people whom we questioned and a greater
susceptibility to injuries in that age group. It is worth noting
that although part of those procedures were performed in unlicensed
establishments none of the people questioned with tattoos reported
bacterial infection, which is recognized to be the most common
complication [24]. The literature data suggest that after body
ornamentation procedures people often develop allergy reactions to
inserted metal salts. Usually these reactions are restricted to the
tattooed area. One of the reactions described was pseudolymphoma
caused by mercury salt used to obtain a red color [21]. Among our
group of people questioned no one reported such complications
despite the presence of red color in tattoos.
One of the most common complications mentioned in the literature
is bleeding. It can be a risk factor for transmitting such viruses
as HIV and HBV, HCV, HDV, HEV and HGV [8-11]. Stirn has established
that bleeding occurs in 10-30% of body piercing procedures and
Armstrong et al. have estimated that bleeding after tattooing can
occur in up to 76% [6, 22]. In our group of people questioned,
bleeding was noted in 12.26% of subjects with piercing and this is
not different from the bleeding frequency in other countries,
however the percentage of bleeding after tattooing is definitely
lower (7.7%). Such a big disproportion in the results can be caused
by the fact that Armstrong took into consideration bleeding that
always occurs during the procedure while the tattoo is being
performed and the people we questioned considered bleeding as a
complication after it. Our research has found that bleeding more
often occurs after body piercing than after tattoo procedures.
Our material suggests that a quite frequent but not serious
complication after tattooing was pruritus in the body area where
the tattoo was carried out (21.63%). In the available literature,
authors do not mention such a complication, probably because they
concentrate on more serious ones [10, 11, 20, 22].
Of the people questioned, none noted complications such as local
and/or systemic allergies or endocarditis. Also nobody mentioned
symptoms which could suggest the presence of blood transmitted
infection.
Infections after body piercing procedure were noted by 25.5% of
questionnaired people, and 5.88% mentioned tissue tearing. Nobody
reported such complications after tattooing. Our comparative study
suggests that complications after body piercing are more common and
more serious than after tattooing.
The data which we obtained show that most tattoos and piercings
are performed in establishments with satisfactory hygiene levels,
that way the risk of complication is minimized.
Conclusion
Body piercing is connected with a higher risk of occurrence of
complications than tattooing. Complications after body piercing are
more serious than after tattooing.
There is social awareness of the fact that complications after
body piercing are more common, that is why procedures of body
piercing are more often done in professional establishments.
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