BODY PIERCINGS AND TATTOOS

DEFINITION

Body piercing and tattooing have become a very popular form of student self-expression.

A tattoo is a puncture wound, made deep into the skin, that’s filled with ink. The skin is punctured with a needle and ink injected. Most commercial tattoos in the United States today are made with a tattoo machine, a handheld electric tool that uses a tube and needle system. It drives the ink about 1/8 in. into the skin (dermis). Complications are relatively uncommon, however, because the skin is breached, skin infection and other skin reactions are possible. Over 200 communicable diseases can be transmitted through tattooing. Sloppy infection control has been linked to outbreaks of methicillin- resistant staphylococcus aureus (MRSA). Tattoos are also estimated to cause more than twice as many Hepatitis C infections as injection drug use. Since tattoo inks are classified as cosmetics, the FDA does not regulate the tattoo industry. Tattoo inks can contain impurities but also may have been manufactured as printing ink or automobile paint. Colorado requires an individual to be 18 years old or have parent consent.

Piercing may occur to just about any body part and be done by a medical professional but more commonly is done in a commercial establishment or by peers. Many teens perform their own piercings. The jewelry in the piercing is often of poor quality metal or may be a screw, nail or some other metal or plastic object.

ETIOLOGY

  1. Students with tattoos may be seen in the school health office as a result of poor aftercare leading to infection or as a result of the tattoo or piercing being done outside a commercial establishment, often by peers. A student may also be seen in the health office to receive routine aftercare for his tattoo. The recommendations for that care can vary from shop to shop and even tattooist to tattooist.
  2. If you know a student intends to get a piercing or tattoo suggest he first research the process. Warn of the dangers of oral piercings which place an individual at high risk for tooth fractures and gum disease.

If he still wants to proceed, suggest he look for or ask about the following:

·  State or local license and/or certification by the Alliance of Professional

Tattooists (for tattooists)

·  An autoclave

·  Fresh disposable equipment

·  Gloves

ASSESSMENT

1.  A variety of complications can be present in tattoos and piercings, including skin irritation, keloid formation, rejection and allergic reactions to dye or the metal. The most common complication from body art is infection.

2.  Examine the site for signs of infection, including green or grey discharge, a discharge with foul odor, swelling beyond normal tissue reaction and increased warmth. Some discoloration (areas of red, brown, or pink), moderate itching and a small amount of whitish-yellow crust is normal and part of the healing process.

3.  Question the student about the recommendations for aftercare provided by the tattooist or piercer.

4.  Keep in mind some studies of high school students have shown an association between body piercing or tattooing and high risk behaviors such as sexual intercourse, binge drinking, smoking, gang membership, truancy and school failure.

MANAGEMENT

Tattoos:

  1. Tattoo aftercare usually includes keeping the tattoo bandaged for at least 24 hours after the tattoo is done and then using warm, soapy water to keep the area clean. Do not re-bandage the tattoo after this time.
  2. For the first 5-7 days after getting the tattoo, an antibiotic ointment should be used.
  3. After the first week, most tattooists recommend switching to a moisturizer such as Lubriderm or Eucerin 3 times a day for at least 2 weeks to prevent the tattoo from drying out.

NOTE: Petroleum jelly, rubbing alcohol, or hydrogen peroxide should NOT be used since they may cause a heavy scab, and dull the tattoo. Petroleum and lanolin products are reported to leach the ink from the tattoo (medical doctors argue this is not true, tattooists insist it is).

  1. Prolonged exposure to water (bath, swimming) or a dirty environment may require sealing the tattoo with a coating of ointment then covering with plastic wrap.
  2. Mild redness and swelling around the tattoo during this time is normal.
  3. Encourage the student to avoid picking at scabs or dried skin while tattoo is healing.

Body piercings:

  1. Body piercings should be kept clean by washing the site daily with antibacterial soap while moving the jewelry back and forth.
  2. Warm salt soaks over some piercing sites (such as a naval) may be very helpful.
  3. Tongue piercings require rinsing the mouth with warm salt water after eating to keep the area clean.
  4. As with tattoo sites, avoid alcohol, peroxide and petroleum jelly. Petroleum jelly is too occlusive and limits oxygen flow to the area, delaying healing.
  5. Do not remove a new piercing while the site is still healing. Piercings heal from the outside inward and can take many weeks to completely heal.
  6. If signs of infection are noted, the site should be cleaned 2 or 3 times a day

and antibiotic ointment applied.

  1. Removal of the jewelry from the piercing should be avoided if possible. The jewelry can actually serve as a pathway for drainage and healing.
  2. Refer to their healthcare provider as indicated for treatment of infection.

FOLLOW-UP

  1. If signs of infection are seen at a piercing or tattoo site, continue to monitor student for appropriate care and healing.
  2. Encourage student to reduce time out of class by doing routine at home before and after school.

BIBLIOGRAPHY

  1. Suyemoto K and Kountz X. Clinical Guidelines for School Nurses. Nashville, TN. School Health Alert; 2002.
  1. Mayo clinic. Tattoos: Risks and precautions to know first. Available at: http://www.mayoclinic.com/health/tattoos-and-piercings/MC00020 Accessed December 11, 2008.
  1. Medscape. Teens and Body Art—Into the Mainstream. Available at : http://www.medscape.com/viewarticle/551430?sssdmh=dm1.249739&src=0_tp_nl_0 Accessed December 11, 2008.
  1. Medical New Today. Teens Warned To Avoid Oral Piercings. Available at:

http://www.medicalnewstoday.com/articles/112348.php Accessed December 12,

2008

  1. ConsumersReports.org. Teens tattoos: Easy to Get, Easier to Regret. Available at: http://blogs.consumerreports.org/health/2008/11/tattoos-and-tee.html. Accessed December 11, 2008.
  1. Tielsch-Goddard, Anna, Adolescent body art: piercings and tattoos in the school nurse’s office. NASN Newsletter. May, 2008:16-17.