Body Piercing: Avoiding Complications

      Although I am much more likely to get an eyebrow lift than an eyebrow piercing, this is not true of many of the patients I see in my clinical practice. Often, during an examination, I will remove a drape to find a little surprise! Or I may be asked in an adolescent examination what I “think about piercing” or to “talk my kid out of that crazy thing.” Research found that 14% of people between 18 and 50 years old had a body piercing in a location other than the earlobe.
      • Laumann A.
      • Derick A.
      Tattoos and body piercings in the United States: a national data set.
      Reasons to pierce vary. It is a form of self-expression and also a way to become a member of a group. Piercing may have religious and spiritual connotations. Others are for sexual pleasure. They are growing in popularity and becoming more accepted in mainstream society. Yet, getting a piercing is an invasive procedure. Knowledge of the risks, precautions, and potential complications is important in assisting patients to minimize the likelihood of encountering serious postpiercing problems.
      Body piercing can be performed by inserting a piece of jewelry through the skin virtually anywhere on the body from the earlobe to the penis. After the piercing site is cleansed, a sterile piercing needle is rapidly inserted through the body part, and the jewelry is then threaded into place. Most piercings are not done with any topical anesthesia. Healing times for body piercings vary by physical location and range from 2 weeks to 9 months. Naval piercings can take up to 9 months to heal because of friction and tight clothing. Facial piercings of the ears (nontragal), eyebrows, lips, and tongue heal more rapidly, usually within 6 to 8 weeks.
      • Laumann A.
      • Derick A.
      Tattoos and body piercings in the United States: a national data set.
      Persons with increased vulnerability to infection and those who have an increased likelihood of hemorrhage may be at greater risk of complications. About a fourth of those with a body piercing report some form of complication.
      • Meltzer D.L.
      Complications of body piercing.
      Common complications include local infection, keloid formation, traumatic tearing, dental fractures, and allergic reactions. Allergic contact dermatitis is the most common local reaction to piercing and usually results from a jewelry choice. The skin surrounding the piercing appears erythematous and crusty. The patient should be instructed to replace brass or nickel with surgical-grade steel, titanium, or 14- or l8-karat gold jewelry. More rare piercing complications that have been reported include human immunodeficiency virus, hepatitis C virus, tetanus, and systemic bacterial infections.
      • Meltzer D.L.
      Complications of body piercing.
      Genital piercings can cause condoms to break and diaphragms to become more easily dislodged during sexual activity.
      Some piercings are more likely to cause infections because of their locations. Genital piercings are particularly vulnerable because of their location, and if they do become infected, systemic infections can quickly follow. Nipple piercings, if infected, can be associated with subareolar breast abscesses. “High” ear piercings through the cartilage of the pinna are associated with poor healing and more serious infection because of the avascular nature of auricular cartilage. To decrease infection risk and promote healing, it is important to avoid unnecessary touching or manipulation of any pierced site.
      Superficial infections tend to have a benign course and respond well to local treatment, including warm, moist packs and application of over-the-counter topical antibiotic ointment. Oral fluoroquinolones have been used effectively in treating more extensive nasal, auricular cartilage infections.
      • Meltzer D.L.
      Complications of body piercing.
      Generally, if a piercing is infected, it is not advisable to remove the jewelry because this may promote abscess formation. Instead, the jewelry should be left in place and rotated gently daily. The site should be washed/rinsed daily with mild soap and water. Although rare, serious abscesses or unresponsive infections after piercings may occur, necessitating intravenous antibiotic treatment or infectious disease consult. An outbreak of Pseudomonas aeruginosa infections was confirmed in 2004, which resulted in several hospitalizations and permanent deformities. All persons with confirmed infections had upper ear cartilage pierced with an open, spring-loaded piercing gun at an ear piercing kiosk.
      • Keene W.
      • Markum A.
      • Samadpour M.
      Outbreak of Psuedomonas aerugosa infections caused by commercial piercing of upper ear cartilage.
      If regret hits, most body piercing sites will eventually heal with jewelry removal. The exception is large-gauged ear piercings. These must be surgically closed. A 22- year-old patient of mine recently tried to join the military and found that they did not view his body art with the same esteem he did. His cosmetic surgical repair before being considered for candidacy was not covered by insurance.
      Almost every state has regulations for the proper sanitation of establishments that offer piercing services. The American Academy of Dermatology gives the following recommendations to consumers regarding elements to evaluate when contemplating obtaining a new piercing:
      • An autoclave should be used to sterilize all nondisposable equipment after each customer. Instruments and supplies that cannot be sterilized with an autoclave should be disinfected with a commercial disinfectant or bleach solution after each use
      • Sterile needle should be used for all piercings
      • The piercer must wash their hands and put on a fresh pair of surgical gloves for each procedure (eg, between ears)
      • A piercing gun should not be used unless the part of the gun that touches the skin is sterile and has never been used before
      • Use appropriate hypoallergenic jewelry. Metal jewelry containing nickel, cobalt or white gold can often cause allergic reactions. Suggest consumers use surgical-grade stainless steel, titanium, 14- or 18-karat yellow gold, or a metal called niobium, especially for initial piercings

        American Academy of Dermatology. Tattoos and body piercings. http://www.aad.org/media-resources/stats-and-facts/prevention-and-care/tattoos-and-body-piercings. Accessed September 22, 2014.

      Acceptance, as well as open and nonjudgmental discussions with patients regarding body piercing, can assist them to evaluate the risks and seek medical care when they have a complication. Early intervention and education may prevent the use of systemic antibiotics in treating issues related to body piercings.

      References

        • Laumann A.
        • Derick A.
        Tattoos and body piercings in the United States: a national data set.
        J Am Acad Dermatol. 2006; 55: 413-421
        • Meltzer D.L.
        Complications of body piercing.
        Am Fam Physician. 2005; 72: 2029-2034
        • Keene W.
        • Markum A.
        • Samadpour M.
        Outbreak of Psuedomonas aerugosa infections caused by commercial piercing of upper ear cartilage.
        JAMA. 2004; 291: 981-985
      1. American Academy of Dermatology. Tattoos and body piercings. http://www.aad.org/media-resources/stats-and-facts/prevention-and-care/tattoos-and-body-piercings. Accessed September 22, 2014.

      Biography

      Section Editor Laurel Halloran, PhD, APRN, is coordinator of the master’s and doctoral programs in nursing at Western Connecticut State University and a family nurse practitioner. She can be reached at [email protected].