Tattoos, piercings move into mainstream but may carry medical, other risks
Cora C.Breuner, M.D., M.P.H., FAAP
AAP National Conference & Exhibition 2017
Tattooing and piercing in young adults occur more frequently than clinicians might
think, with tattooing far more accepted than it was 15 to 20 years ago. Many young
adults get tattoos or piercings as a form of self-expression, empowerment and autonomy
but may not understand the potential risks, complications and effects on future employment.
The new AAP clinical report Adolescent and Young Adult Tattooing, Piercing and Scarification from the Committee on Adolescence describes the types and methods used to perform
body modifications, potential medical complications and how to talk about these topics
with patients and families.
When counseling teens, pediatricians can advise them to do some research and to think
hard about why they would like to have a tattoo and where on their body they want
it. While societal acceptance of tattoos and piercings has increased, there still
may be repercussions. In a 2014 survey, 76% of 2,700 people interviewed said they
believed that a tattoo or piercing had hurt their chances of getting a job.
Changing your mind about a tattoo can be costly: Laser removal can range from $49
to $300 per square inch of treatment area, according to the report.
While teens usually must be at least age 18 years to get a tattoo, regulations vary.
Pediatricians are encouraged to learn about their state’s laws related to minors obtaining
tattoos and piercings.
“In most cases, teens just enjoy the look of the tattoo or piercing, but we do advise
them to talk any decision over with their parents or another adult first,” said David
A. Levine, M.D., FAAP, a lead author of the report. “They may not realize how expensive
it is to remove a tattoo or how a piercing on your tongue might result in a chipped
Proceed with caution
The rate of complications from tattoo placement is unknown but believed to be rare
and should be discussed with patients. The most serious complication from any form
of body modification is infection. Before getting a tattoo or piercing, one should
make sure the salon is sterile, clean and reputable. Infection control should mirror
that of a doctor’s office.
In addition, the facility should be regulated by the state. Reputable tattoo parlors
and piercing salons should provide clients with a list of do’s and don’ts on how to
care for the area that was worked on and what signs might indicate a problem.
Individuals considering a tattoo should ensure their immunizations are up to date
and that they are not taking any medication that compromises their immunity.
The report also offers guidance for pediatricians on how to distinguish typical body
modification from more dramatic or intense efforts to harm oneself, called nonsuicidal
self-injury syndrome. The syndrome, which includes cutting, scratching or burning
oneself, is a more impulsive or compulsive action that is associated with mental health
disorders. Those who self-injure expect relief from a negative emotion.
Advice for pediatricians
Tattoos and henna:
Remind teens and their families that tattoos are permanent and removal is difficult,
expensive and only partially effective.
Those with a history of keloid formation should avoid body modifications that puncture
Assess the sanitary and hygiene practices of the tattoo parlors and tattoo artists.
Seek medical care if there are signs and symptoms of infection. Lesions that appear
to grow or change within a tattoo require evaluation for neoplasms.
There is a risk of hemolysis with red henna temporary tattoos for those with a positive
glucose-6-dehydrogenase deficiency. Black henna temporary tattoos should be avoided
because of the significant rate of sensitization.
Patients should be counseled about the potential effects on employment and education
if tattoos are visible.
Piercings and stretching:
Rinsing with nonprescription oral cleansers or topical application of cleansers can
help prevent infection after oral piercing.
Antibiotic agents with good coverage against Pseudomonas and Staphylococcus species (e.g., fluoroquinolones) are advised when treating piercing-associated infections
of the auricular cartilage.
At piercing establishments, the piercer should be observed putting on new disposable
gloves and removing new equipment from a sterile container.
Teens contemplating tongue piercing should know of the high incidence of tooth chipping
that can occur.
Remind patients who have piercings to remove all jewelry during contact sports to
avoid endangering the wearer and other players. Jewelry that interferes with mouthguards
or protective equipment also should be removed before play. Nipple jewelry should
be removed before breastfeeding.
Counsel teens about potential implications on employment and education if piercings
Inform teens with a personal or family history of keloids of the risk associated with
scarification (the practice of intentionally irritating the skin to cause a permanent
pattern of scar tissue) and other body modification processes.
Infections resulting from scarification may be treated like other skin or soft tissue
Dr. Breuner, a lead author of the clinical report, is chair of the AAP Committee on