A new review provides emergency physicians (EPs) with the tools to assess the lifestyle and social background of their patients, and understand the medical complications that may arise as a result of body modifications such as tattoos and piercings.

Researchers at the University of Southern California (Los Angeles, USA) found that most complications associated with tattoos are related to infection that can be traced back to an individual tattooist practicing a nonsterile technique. In particular, the jail and intravenous drug-using population is at risk for hepatitis B and C, HIV, and Methicillin Resistant Staphylococcus aureus infection (MRSA); even syphilis has been transmitted by a tattoo artist licking the tattoo needle. In many cases the tattoo is not correctly linked to the medical problem because the patient may have multiple risky behaviors; failure to recognize a tattoo as the source of a complication may lead to incorrect therapy.

Complications of piercings are more common than those of tattoos are, and studies show rates as high as 9%. The types of complications include local or systemic infections, traumatic insertion, poor cosmesis, and rejection of foreign body, as well as migration and embedding. Metals used in piercing include stainless steel, gold, titanium, and various alloys. When these alloys contain nickel, there are associated allergic skin reactions and contact dermatitis. Rarer complications of piercings include bacterial endocarditis, tetanus, piercing migration with embedding, and even a case reported of appendicitis from a swallowed piercing that occluded the appendiceal aperture.

However, The EP should be more concerned about mental illnesses and suicidal behavior in those with body modifications. Studies suggest that those with tattoos were impulsive, hostile, and prone to delinquent behavior. A data analysis of 4,700 individuals who responded to a survey on a website for body modification found a high frequency of abuse in the background of those who participated; 36.6% of the males had suicidal ideation and 19.5% had attempted suicide. For females, a significant higher suicide rate was found, with percentage values of 40.8% and 33.3% respectively. Piercing is also more common among women rated as having low constraint or high negative emotionality, and less common among those with high positive emotionality. No association, however, has been found with eating disorders. The study was published in the December 2011 issue of the Western Journal of Emergency Medicine.

“Tattoos and piercing are directly responsible for an increasing number of emergency department visits due to both immediate and delayed complications,” concluded lead author Michael Urdang, MD, and colleagues of the department of emergency medicine. “The emergency physician armed with knowledge about tattoos and piercing body modifications can forge more functional doctor patient relationships, obtain critical historical data, and provide better treatment and referral for this patient population.”

Tattoos and piercing are ancient practices of body modification; the word tattoo comes from Polynesia, and describes the tapping noise made by a tattoo needle on the skin (tatau or tatu). Piercing, including the ear lobe, is also an ancient process, first recorded in the Middle East more than 5 thousand years ago. Social acceptability of these practices varies widely from culture to culture, with Catholicism and Judaism banning the practice of tattooing. Once relegated to the margins of society, tattoos and piercings are now more common across all ages and both genders.

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