Body Piercing

Introduction

Creativity and ubiquity are the only constants of body piercing. Yet, no matter what one’s opinion is about body piercings, don’t become distracted by them and delay important medical care. Body piercing has been around for centuries in various societies as part of ritualistic or cultural practices, and now it is rapidly becoming a worldwide mainstream fashion trend, especially among young adults aged 18-25 years, body piercing is defined as the insertion of a needle to create a fistula-like opening (into either cartilage or skin) for the introduction of decorative ornaments, which can include insertion of jewelry, plastic or wood plugs, beads, or pearls. Women tend to report obtaining body piercings more so than men do.

Body Piercing Regulated Environment

An actual body piercing procedure only takes a few moments, but given the invasive technique of the procedure, an earlier study cited frequent infections and skin irritations as prevalent piercing site problems, often because no aftercare instructions for proper skin treatment were provided. Now, considering the overall amount of body piercing worldwide and the presence of a better (but certainly not perfect) regulated body art environment, While most body piercings are not problematic, the potential for localized infections, as well as associated systemic diseases, is present so long as the piercing site remains open.These infections may become an even more invasive problem with the emergence of community acquired methicillin resistant Stapthylococcus aureus (CA-MRSA).

Blood transfusions have also been affected by the increase in body piercing. For many years, individuals with new piercing could not donate blood for at least 1 year following the piercing, if body art was obtained in regulated areas. Current evidence indicates disease transmission has not increased with these new regulations.

Pierced Seeking Prompt Treatment?
Many individuals with body piercings do not perceive their body art as “permanent”; frequently they say, “If I don’t like it, I can remove it.” They are often aware of the procedural risks; however, when initial site irritation, pain, or oozing occurs, most skin problems may be dismissed or self-treated.Other times, individuals are “embarrassed,” thinking the infection could be their fault, and/or “fear” that the jewelry needs to be removed. Additionally, findings from recent studies suggest that these individuals look to the internet or return to the piercer for assistance, instead of seeing their health care provider, due to the clinicians’ lack of adequate knowledge, judgmental perspectives about body art, and limited educational resources about piercings.

Where was the Piercing Obtained?
Stores/kiosks in shopping malls provide ear lobe and high rim ear piercings using piercing guns, and sell benzalkonium chloride solution as their after-care product of choice. This solution does not have adequate microbicidal activity against Pseudomonas aeruginosa infections and has been frequently mentioned in outbreaks of auricular chondritis. Additionally, limited employee training and supervision, along with inadequate quality control measures have also been reported.

What Type of after-care was Done?
Diminished skin integrity is greater with newly acquired body piercings, especially from procedures obtained during warm weather months. In a regulated body art environment, piercing artists emphasize conscientious care of the piercing site following the procedure with careful monitoring of the site until it is completely healed. While healing times are dependent on site location, facial piercings usually heal within 2 months, and covered areas can take up to 6 months. Yet, a completely healed site requires judicious care of the piercing site for at least 1 year until the skin epithelializes, “toughening up” the area for the adjustment of wearing various piercing inserts.

What Kind of Jewelry was Placed in the Site?
Due to the overall increase in jewelry containing nickel, there has been a marked increase in contact dermatitis related to nickel allergy, especially if it is purchased in shopping malls. Carefully selecting piercing jewelry (comprised of niobium, titanium, 300 grade surgical steel, or gold) that is found in piercing studios helps avoid allergen exposure, scarring, and risks of delayed infection.

Should Jewelry Be Removed or Not?
Retaining the jewelry at the site when an infection initially occurs, allows for better drainage and epidermal healing, whereas removal can potentiate abscess formation in deeper skin structures. However, if there is not resolution within 5“7 days, the jewelry should be removed, followed by surgical incision and drainage, and possible hospitalization with intravenous antibiotic therapy, especially for high ear-rim piercing infections.

Local Complications:
Secondary trauma from body piercing can occur frequently at the naval, ear, nose, tongue, chin, eyebrows, genitals, and nipple. Common complications include bleeding, bacterial or viral infections, mechanical tissue tearing, keloid scarring, nerve impairment, and allergies. These complications can arise from the body piercing procurement and/or limited procedural after-care. Embedded earrings are also frequently seen. Exposed wounds from piercing inserts can also occur from physical assaults, motor vehicle accidents, or aggressive contact sports. Additionally, as more people retain their body art for longer periods of time, other effects can evolve, which may involve further invasive, corrective procedures from a specialist.Management of Infections

Bacterial skin infections at or near the site are considered the most commonly reported complication of body piercings, with causative organisms primarily consisting of 2 gram-positive bacteria: Staphylococcus, and group A Beta-hemolytic Streptococcus, and 1 gram-negative bacteria: Pseudomonas.[24] Ideally, pharmacological interventions would be pathogen-specific, based on cultures of the affected site. However, due to the length of time cultures take to be processed, it is not always reasonable to delay treatment, as a more severe infection can ensue if left untreated.

Current infectious disease guidelines recommend that the majority of minor skin and soft-tissue infections may be treated with penicillins, first-generation or second-generation oral cephalosporins, macrolides, or clindamycin. Of note, though, is that there is growing resistance of MRSA strains to clindamycin, in the range of approximately 50%. Ideally, after initiation of antibiotic therapy, patient follow-up at 24 “48 hours is important. If the patient is not demonstrating a positive response to therapy, the clinician should strongly consider that the progression of infection may be a result of resistance or a sign of a more severe infection. In the event that the infection causes the formation of skin abscesses, the clinician should consider a more aggressive combination approach to therapy, including antibiotics and possible incision and drainage of related skin abscesses.

Conclusion:
While piercers are knowledgeable regarding the techniques and procedures of body piercing, treatment for health concerns and complications related to piercings should be provided by knowledgeable clinicians. Non-judgmental, informative care is crucial when complications arise. Yet, as you work with those who have piercing complications, remember that removing a piercing does not remove the individual’s motive or rationale for obtaining the piercing. Often, within about 6 months they will obtain another, so applicable education about piercing care remains vital for preventing further or repeated sequelae.
Recommendations for care of a new piercing as defined by the Association of Professional Piercers include:

• Instruct patients to wash the piercing site with soap and water or a diluted saline solution (1/8 tsp of salt to 8 oz of water) twice per day, because piercing tracts can become portals or reservoirs for viruses and bacteria.
• Recommend the use of antiseptic mouthwash (alcohol-free) for oral piercings.
• Instruct individuals with oral piercings to use ice chips or other cool fluids to reduce swelling and ease discomfort during the initial healing phase.
• Advise against the use of alcohol, Hibiclens®, hydrogen peroxide, Bactine®, and Betadine® in piercing care.
• Encourage patients to search the Association of Professional Piercers website for further educational material regarding each type of piercing.

Dr. Wesam Kadhum
Lecturer -Dermatology Dept
GMC Hospital, Ajman