Tattoos, Body Piercings, and Other Skin Adornments
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Tattoos, body piercings, and other skin adornments have become quite popular in modern society. These practices date back almost 5,300 years and may be fascinating as a part of many cultural rituals, or as signs of beauty; however, they may lead to problems such as keloids (thick scars), infections, allergies, growths, or permanent holes when people want them removed.
The Five Major Tattoo Types
- Traumatic tattoos
- are caused by the unwanted imbedding of dirt or debris beneath the skin which leaves an area of pigmentation after healing. This commonly occurs in "road rash" after a bicycle or motorcycle accident, or a puncture injury from a pencil known as a "graphite or pencil-point" tattoo.
- Amateur tattoos
- are placed by the people themselves, or by their friends, and often show very little artistry or detail. The most common method involves placing India ink beneath the skin with a pin. Pen ink, charcoal, or ashes are also used as the pigment.
- Professional tattoos
- take two forms: cultural and modern. Cultural tattoos are placed using the time-honored methods of a certain cultural ethnicity or heritage such as the South Pacific Islands. Modern tattoos are performed using the "tattoo gun" and are placed by "artists" who are paid for their work. A variety of pigments for different colors are used and their artistry varies from poor to fantastic.
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Traumatic road tattoo of face
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27 months after treatment with laser surgery
- Medical Tattoos
- are commonly used to delineate permanent landmarks for radiation therapy and is placed by a physician.
- Cosmetic Tattoos
- are used for permanent make-up such as eyeliner, lip liner, lipstick, blush, hair, and eyebrows. Cosmetic tattooing is also used to replace a nipple after breast surgery, to camouflage vitiligo (the absence of pigment color), or to cover an undesired tattoo.
Modern professional tattoo
Tattoo Complications
No matter what type of tattoo, there are always risks and possible adverse reactions that may require treatment. Infections may occur directly after tattooing. Impetigo, a staph infection, or cellulitis, a deeper skin infection, may develop. There is also a risk of bloodborne diseases such as hepatitis and HIV, although there has been no documented spread of HIV by a professional tattoo artist with experience. Universal precautions should be used by tattoo studios. Look for inspection certificates to be certain.
Hypersensitivity (allergies) may also develop to tattoo pigments. An allergy to mercury in the red color pigment called cinnabar was very common, but is no longer used. A chemical called para-phenylenediamine, which is applied to the skin in temporary henna tattoos, frequently causes contact dermatitis.
Tattoos may interfere with proper medical tests like an MRI; misdiagnoses could be made due to the iron oxide and heavy metal pigments in the tattoos.
Tattoo Removal
With time, many patients decide they no longer want to have a tattoo. Although there are many improved methods for the removal of tattoos like laser surgery, excision, dermabrasion, salabrasion, and cosmetic over-tattoo, it is still time-consuming, expensive, and may leave scars or discolorations. The treatment of tattoos with laser may entirely remove the pigment or only bring fair results. The skin is rarely as perfect as it once was prior to getting the tattoo.
Arm tattoo
10 months after removal with laser surgery
Body Piercing
Body piercing is another form of skin adornment. Jewelry is worn through the skin. Female ear piercing has long been accepted in Western culture, but in the last 25 years, male ear piercing and the piercing of other body areas has become widespread. Navel piercing has become fashionable. More extreme piercings of the eyebrows, nipples, lips, tongue, and genitals have also become common. Oral and genital piercing is often associated with reported sexual enhancement. Originating in Asia, artificial penile nodules (penis marbles) are made by placing plastic beads or pearls, etc. beneath the skin of the penis.
Tongue piercing
Body Piercing Complications
The most common complication of piercing is the development of keloids. This is seen frequently in African Americans. Treatment of keloids can be difficult requiring surgery, and/or injections of steroids, or interferon. Topical creams, cryosurgery (liquid nitrogen), and a combination therapy can be used.
Vascular growths called pyogenic granulomas. These may bleed and must be removed.
Infection may be a problem. Cartilage piercing at the edge of the ear (pinna) increases the chance of a bacterial infection called pseudomonas. Abscess formations, chondritis (inflammation of cartilage) of the ears, Candida (yeast) infections, toxic shock syndrome, and sepsis (severe total body infections) may occur. There is risk of bloodborne diseases such as hepatitis and HIV especially among amateur piercers who do not clean equipment properly.
Embedding of jewelry (where the skin grows over the jewelry) may occur, and is often the result of studs that are too tight.
Hypersensitivity (allergies) to the nickel in some jewelry develops as an itchy, red skin reaction (dermatitis), and is chronic. People who are allergic to nickel should only wear stainless steel, platinum, or gold jewelry.
Pyogenic granuloma - Navel piercing
Piercing Removal
The forcible removal of the jewelry by accidental trauma may cause a permanent deformity which can be repaired with surgery. Trauma to the teeth from oral jewelry may require restorative (crowns or bonding) dentistry.
Since piercing is not "accepted" by many employers, removal of the jewelry may leave unsightly "holes," which also requires surgery to correct.
Other Skin Adornments
Some individuals want to form a keloid. The more permanent the scar, the better. Scarification is a skin adornment that takes two forms - branding and cutting. Branding is the use of a hot metal design, which burns the design into the skin. This is a recognized ritual behavior in some college fraternities. Cuttings are also done in the skin using a sharp knife or scalpel to leave permanent scarifications.
A newer body modification procedure includes tongue splitting which gives a person a forked split tongue. Besides the complications of infection and bloodborne disease, this may lead to a permanent lisp.
Think before attempting any of the procedures. Only use a trained professional with experience and proper hygienic technique. Be sure of what you want and discuss it. If there is a problem, see a dermatologist quickly.
To learn more about tattoos, body piercings, and other skin adornments, call toll-free (888) 462-DERM (3376) to find a dermatologist in your area.
AAD Web site: www.aad.org
Toll-free: (888) 462-DERM (3376)
Images used with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides
© 2004 American Academy of Dermatology
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