Body-modifying concepts and dermatologic problems: tattooing and piercing

Abstract

Recently, piercing and tattooing have gained increasing popularity worldwide, through all social classes and age groups. Besides pierced ear lobes, piercing of the tongue, nose, nipples, bellybutton, and even the genitals is quite common.

The variety of tattoos range from temporary henna tattoos to permanent makeup and permanent tattoos, where the pigments are deposed in the dermis.

These trends are supplemented by more invasive methods of body modification such as implanting, scarification, or branding.

Parallel with the increasing popularity of piercing and tattoos, the knowledge about associated complications rose. Complications depend substantially on the circumstances in which body modifications are applied, the materials used, and the body region concerned.

This article gives an overview of the most common complications of body modification methods, which mainly result from shortcomings in the application itself or in hygiene regimens. Consequences may be as severe as life-threatening events or permanent malfunction of different organs.

Introduction

The term tattooing goes back to a Tahitian term (Ta tatau, meaning appropriate, balanced, and fitting) and describes the implantation of pigment in the skin.¹ Skin perforation (piercing) to attach jewelry made of metal, plastic materials, or bone has been performed for centuries and has been widely practiced, especially on the Asian, African, and American continents.

Tattoos and piercing are fashionable not only in young age groups. Although exact data are missing, it is estimated that roughly 10% of the population are wearing a tattoo. An estimated 7 to 20 million Americans may be tattooed.² Concerning piercing, these rates are even higher because of the wide practice of earlobe piercing. In a recent survey of New York area college students, 60% of the women and 42% of the men students (n = 482) were pierced.³

The individual rationales for the decision to get a tattoo are quite heterogeneous. The deciding factors are probably individual attitude, the circumstances of life, or maybe group pressure.

In the past, a majority of the general population disapproved of tattoos and piercing, with one exception: the earlobe piercing. In the last 2 decades, especially, tattoos gained more and more acceptance, probably because very widely known icons from sport and media wear more and more tattoos in public. This trend is accompanied by a substantial increase in associated complication. Most general practitioners in the United Kingdom (95%) saw at least 1 complication after piercing.⁴ Thorough knowledge about frequent complications and their management as well as common reconstructive strategies of defects caused by piercing is of increasing importance.