In the adolescent years, it’s all about "YOLO" (You only live once!), which is the premise for many of the behaviors that primary care doctors see during this time. Many teens come into the office covered in piercings and tattoos. My favorite is the boyfriend’s name tattooed across an arm, a leg, or even the buttocks. You can’t help but think to yourself, "You are going to regret that one, for sure!"
Although tattooing and piercing are practiced in many cultures, extensive body art and multiple piercings are practices that are often done by adolescents who also engage in other risky behaviors. ("Tattooing in adults and adolescents," UpToDate, Aug. 29, 2013). One study showed that this population is much more likely to engage in sexual activity, binge drinking, marijuana smoking, and fighting significantly more than were non–tattooed adolescents.
Dr. Francine Pearce
As a primary care doctor, you’re less likely to be asked for advice about getting a tattoo or piercing than you are to be asked to fix the mishaps of these practices, but it is still important to be up to date on the potential risks. Adolescents are at an even a greater risk than are adults for complications because, in most states, children under age 18 years are required to have parental consent to get a tattoo or piercing. Therefore, this age group is more likely to seek out illegal or unlicensed businesses. Where there is a greater risk of substandard protocols and hygiene, the risk of infection increases. Many of the infections come from nonsterile cleaning fluid and water used in the tattooing or piercing procedure. Improper education of the client on aftercare is another contributing factor.
Local infections are the No. 1 complication of tattoos and piercings. Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) are the most common causes of infection, but several other infectious agents have also been identified. It is not uncommon to have outbreaks of a particular infection occur because a certain provider is not using appropriate hygiene or is a carrier of one of the blood-borne illnesses.
Some caution tattoo seekers about blood-borne infections such as HIV, hepatitis C, and hepatitis B. But the number of such infections is currently relatively low. In fact, the research does not show a clear causal relationship between tattoos and piercings. Instead, it shows that, because adolescents who get tattoos are risk takers and are more likely to be intravenous drug users, they are also more likely to become infected with these diseases (Pediatrics 2002;109:1021-7).
A major complication that should not be overlooked is infective endocarditis. Although rare, if a teen presents 1-2 months after a body piercing or tattoo and has unexplained fevers, weakness, arthritis, and malaise, a work-up should be done with infective endocarditis in mind.
The role of the primary care doctor in this situation is to educate patients on appropriate practices so that they will be less inclined to have an inexperienced and unlicensed person perform body art procedures on them. Patients should expect the skin to be cleaned initially with alcohol and iodine, and sterile water and gloves to be used in the procedure. A clear understanding of the potential health risks and life-long complications should also help to deter them unsafe practices.
In the event of a local infection, it may actually be better to leave the piercing in because it allows for drainage. Antibiotic coverage that includes MRSA will also speed recovery.
Tattoos and piercing can be safe when done properly. Being proactive and sharing the appropriate information can help an adolescent make a better decision so that not only do they get to live it up, they can live a healthy long life as well
Dr. Pearce is a pediatrician in Frankfort, Ill. E-mail her at pdnews@frontlinemedcom.com.