ARTICLE
Auteur(s) : Petra Gutsche1, Gottfried
Schmalz2, Michael
Landthaler1
1Department of Dermatology, University of Regensburg,
Franz-Josef-Strauss-Allee 11, D 93051 Germany
2Department of Operative Dentistry and Periodontology,
University of Regensburg, Germany
accepté le 2 Août 2007
Body piercing has become increasingly popular in all age groups
in the western world. Although the localisations of piercing and
piercing procedures as well as their complications and effects on
health care systems have been described and discussed in the
medical literature [1-3], little data exists on the prevalence of
piercing in European populations. The aim of the present study was
therefore to determine the prevalence of piercing in our
region.
Methods
Our six-month evaluation included 5,000 patients of a private
dental practice, two private dermatology practices and the
out-patient clinic of the Department of Dermatology at the
University of Regensburg. The questionnaire presented to each
patient required information on the age and gender of patients, the
prevalence of piercing, the number of piercings, the age at the
time of piercing and possible complications. A total of 4,505
patients (2,588 females, 1,917 males) were evaluated.
Results
Since the piercing of earlobes is very common in both women and men
(84% and 22% of patients in the present study), this particular
localization was excluded from the evaluation. In our study, we
found 389 patients (8.6%) with piercings other than that of
earlobes.
The localization of piercings is summarised in table 1. Most localizations were equally
distributed in females and males, but differences could be observed
for umbilicus (more females than males), eyebrows (more males than
females), nipples (more males than females), and genital areas
(more males than females).
310 females with piercings were found (12.0%) and 79 males
(4.1%). However, since these figures also included children and
patients older than 50 years of age, the prevalence of piercing in
the middle age groups was much higher.
The group between 15 and 30 years of age, for example showed a
prevalence of 27.2%. Furthermore, some patients had more than one
piercing (figure
1), hence the total number of piercings amounted to
506.
A large number of piercings (52.8%) were obtained under the age
of consent of 18 years (figure 2). No age
difference could be detected for the time of piercing regarding
individual localisations, but genital areas, nipples, and band of
the tongue were pierced at a later age than lips, eyebrows,
tongues, and nostrils.
Reports on complications were frequent, 32% of patients reported
an intolerance of nickel while 18% of patients had suffered from
temporary inflammation and 14% from infections with pus secretion.
Patients with piercings of nipples (7 out of 12), umbilicus (26 out
of 117) and genital area (4 out of 7) reported more complications
compared to patients with other localizations like the concha (36
out of 171).
Table 1 Local distribution of 506 piercings in 389
patients (310 females, 79 males)
|
|
Female
|
Male
|
|
n
|
n
|
%
|
n
|
%
|
|
Concha
|
171
|
142
|
45.8
|
29
|
36.7
|
|
Umbilicus
|
117
|
114
|
36.8
|
3
|
3.8
|
|
Nostril
|
84
|
72
|
23.2
|
12
|
15.2
|
|
Eyebrow
|
49
|
25
|
8.1
|
24
|
30.4
|
|
Tongue
|
32
|
28
|
9.0
|
4
|
5.1
|
|
Nipple
|
12
|
3
|
1.0
|
9
|
11.4
|
|
Lower Lip
|
10
|
9
|
2.9
|
1
|
2.4
|
|
Upper Lip
|
8
|
7
|
2.3
|
1
|
1.3
|
|
Frenulum
|
8
|
8
|
2.6
|
0
|
0
|
|
Genital area
|
7
|
4
|
1.3
|
3
|
3.8
|
|
Septum of nose
|
3
|
1
|
0.3
|
2
|
2.5
|
|
Chin
|
2
|
2
|
0.6
|
0
|
0
|
|
Tragus
|
2
|
2
|
0.6
|
0
|
0
|
|
Neck
|
1
|
0
|
0
|
1
|
1.3
|
|
506
|
417
|
|
89
|
|
Discussion
The rather high prevalence of piercings present in the population
of our region corresponds with a report from Australia. In a random
sample survey of individuals aged 14 years and over, Makkai and
McAllister found 8% of the population to have piercings [4]. In
contrast, Mayers et al. [5] established a 51% prevalence of body
piercing in university undergraduates. In agreement with this study
we found the highest numbers of pierced patients in this age group.
Interestingly, more than 50% of patients were pierced under the age
of consent. Therefore, the legal aspects of such a physical injury
ought to be discussed as well as the many possible complications of
piercing. A recent US-study showed that 14% of women and men aged
18 to 50 years had piercings [6].
The fact that 32% of patients reported an intolerance/allergy to
nickel is noteworthy since patients remain allergic to nickel their
whole life which presents serious implications for their private
and professional lives. According to McDonagh et al. [7], the
increase in the frequency of nickel sensitivity in women with
pierced ears compared to those with unpierced ears was highly
significant.
Furthermore, more recent reports have combined an increased
incidence of nickel and cobalt allergy in pierced versus unpierced
male subjects [8, 9] and in patients with multiple piercings [6].
Jewellery, especially ear-piercing, is also one of the most
predisposing factors for nickel allergy in children [10].
Since nickel-containing costume jewellery is nowadays forbidden
in Germany and the European Community, the number of nickel
allergies is expected to drop in the near future. A special variant
of contact reaction to piercings are sarcoidal granulomas at the
pierced site [11-13].
Although severe or life threatening complications were not
reported in our study group, physicians should be aware of medical
complications, such as bleeding, tissue trauma as well as bacterial
and viral infections (HIV, hepatitis) [14-16].
In a recent study from Poland, 45.6% of pierced patients
reported complications after piercing like bleeding (12.25%), local
infection (25.5%), tissue tearing (5.88%) and hypertrophic scars
(1.96%) [17].
Complications also depend on individual locations, for instance,
keloids are more likely to develop when ears are pierced after the
age of 11 than before [18], whereas mastitis may occur after nipple
piercing [19].
Oral piercings mainly involve tongues and lips. As the tongue is
a very vascularized organ, tongue piercings may lead to
complications like extensive haemorrhage that might even
necessitate hospitalisation. Furthermore, extensive edema and
infections including abscess formations have been reported after
tongue piercing, due to the large number of bacteria in the oral
cavity [20, 21]. Tracheotomy has been described as necessary
treatment in a case of LUDWIG’s angina caused by anaerobic bacteria
[20]. Another infection resulted in a bifid tongue, i.e. the
division of the tongue along the anterior midline [22]. In the long
run, tongue piercings may cause gingival recessions lingually,
while lip piercing may result in recession buccally, mainly in the
adjacent lower front teeth (figure 3). Loss of
periodontal attachment was associated. Furthermore, diastemata in
the upper and lower jaw as well as chipping and tooth fractures
including both enamel and dentin have been described after tongue
piercing [23-30]. In some cases, parts of the piercing ornament
became buried in the deeper tongue tissues and had to be removed
surgically [31]. Oral piercing has finally been reported to
stimulate saliva production and to impede vocalization,
mastication, swallowing and speaking [32]. It also interferes with
radiographic examinations of the oral cavity, e.g. with panorama
techniques. Therefore, temporary removal of oral piercings during
dental treatment has been recommended.
Conclusion
The study presented proves the high prevalence of piercing. Since
diseases of the oral mucosa are an integral part of dermatology, we
should also be familiar with the different types of oral piercings
available as well as their short- and long-term complications.
Acknowledgements
Financial support: none. Conflict of interest: none.
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