Millions of people wear piercings (ear piercing, nose piercing, belly piercing) in the world. Percutaneous body jewelry is particularly popular with adolescents and younger. But it can lead to serious complications; an increasing issue for doctors and health politicians.
Percutaneous body jewelry
Body jewelry (ear piercing) has become a fashionable mass phenomenon that doctors have to deal with more and more often. Piercing jewelry can interfere with imaging diagnostics or with medical interventions such as operations.
And, of course, the jewelry itself can cause complications. This is why there is intensive discussion internationally about the medical and health policy aspects of damage caused by piercing, but also by tattoos or certain cosmetic surgeries.
Fundamentals of the discussion
Among the fundamentals of the discussion are efforts to determine the prevalence of tissue-damaging body jewelry and associated complication rates. Just a few weeks ago, British public health researchers published an extensive study that is representative of Great Britain (1). There are also figures and – increasingly frequently – publications from the United States on casuistries of complications.
In the UK, 10,503 citizens over the age of 16 were asked if they had ever had a piercing. When piercing (drill through, pierce) a piece of jewelry is attached after perforating tissue with a hollow needle; piercing the earlobes is not generally considered piercing. According to the definition, which excludes the earlobe, ten percent of all Britons are or have been pierced, in the group of 16 to 24-year-old women 46.2 percent. Women are three times more likely to wear percutaneous body jewelry than men. The average number of piercings across all respondents was 1.7, meaning many Brits have multiple piercings.
Women pierced more often
According to this, the prevalence is for piercings 6.5 percent. That means: Approximately 5.3 million European are pierced. 1,000 East and West European aged 14 to 92 were interviewed (n = 2,043). In the 14-24 age group, 38 percent of women and 16 percent of men had a piercing, and 41 percent of women and 27 percent of men of this age had tattoos and/or piercings.
Frequency and type of complications during piercing
Since the frequency and type of complications depend, among other things, on the location of the piercing, the choice of the body region is interesting: Brits prefer the navel (33 percent), followed by the nose (19 percent) and ear (13 percent). Nine percent of the jewelry was applied to the tongue and nipples, eyebrows (eight percent), and genitals (two percent).
Head and neck piercing
In the United States, head and neck piercings seem to have predominated, especially on the ears (4, 5). There is no comprehensive survey on the localization of piercings in the United States comparable to the British study.
In a study by the Bremen Central Hospital, 2,000 colleagues working in private practices or clinics were asked to document the piercings. They had seen in the head and neck area of patients and asked about other piercings and complications (6th). Piercings were documented in 273 people. 44.8 percent were on the ear (without lobules) 22.8 in the area of the nose. 15.3 percent on the tongue, 9.8 percent on the Eyebrows, six percent on the lip, and the rest on the lip frenulum and chin.
Additional body sites pierced included the belly button (13.1 percent), nipples (2.2 percent), and genitals (0.8 percent).
The complication rate for piercing essentially depends on
- the localization
- the material used
- the experience of the piercer
- the hygienic conditions during the piercing and
- The aftercare.
The British researchers have attempted to quantify health problems associated with piercing by asking, "Have you had any swelling, bleeding, infection, allergy, avulsion, or another injury from the piercing, or no health problems?" (1)
- At 27.5 Percent piercings experienced one of the problems, with 31 percent among 16- to 24-year-olds.
- 13 percent of all piercings required professional help from pharmacists, doctors, or piercers (15 percent among 16 to 24-year-olds).
- One in 100 piercings in 16-24-year-olds resulted in hospitalization.
In the Bremen study (6th) under the leadership of Prof. Dr. Medical Krause stated that 28 percent of the pierced people had problems with the healing process, and nine of them were therefore treated in a hospital.
The main risks of piercings are bacterial and viral infections
The main risks of piercings are bacterial and viral infections (including necrosis), bleeding, tears, allergies, excessive scarring (keloids), and foreign body granulomas.
The most common causative agents of bacterial infections are Staphylococcus aurous and S. epidermises, type A and B streptococci, Pseudomonas spp., and mycobacteria (5, 7, and 8). In many cases, contact lens infections can also be traced back to infection through piercing: the germ colonization of the lens and piercing piece are then identical (6). Observed viral infections include hepatitis and HIV (7).
According to the current British study (1), the most complication-prone for the 16 to 24-year-old age group are piercings
- in the genital area (44.6 percent)
- on the nipples (24.7 percent)
- on the tongue (24.3 percent )
- on the navel (14.8 percent)
- on the ear (14.4 percent) and
- On the nose (8.9 percent).
"In the female genital area, it is primarily inflammation, tears, and bleeding that we see as complications,” For example, she had to sew up a tear in a patient with a clitoral piercing under general anesthesia.
Injuries to nerves and larger blood vessels can occur on the male genitals (penis, scrotum), as well as ascending infections, which – as with piercings on the female genitals – can lead to infertility. Urethral ruptures have been observed with penile piercings (9). They can also damage condoms.
A possible complication of breast piercing
A possible complication of breast piercing is the obliteration of the mammary ducts with lactation disorders in women.
Abscesses also occur, sometimes with massive lesions, which usually require systemic antibiotics and often also surgery (7, 8). Endocarditis has been described in isolated cases after nipple, nose, chin, and navel piercings. In some cases, heart valve surgery was necessary for addition to antibiotic treatment (1, 10, and 11).
According to the current British study, navel piercings cause complications in 15 percent; earlier studies put the frequency at up to 40 percent (7th). "We are particularly concerned that we are already seeing complications from navel piercings, such as phlegm on, in very young girls, i.e. 10 to 12-year-olds," said Dr. medical Wolfram Hartmann, President of the professional association of pediatricians, the DÄ. Granulomas, some of which were inflamed and weeping and which had not healed even weeks after the piece of jewelry was removed, were diagnosed (12).
Local infections
are common with "high" ear piercings Multiple and "high" piercings that perforate the cartilage are the main sources of complications in the ear, according to Dr. medical Sebastian Strieth from the clinic for ear, nose and throat medicine at the Klinikum Großhadern of the Ludwig-Maximillian’s-University Munich ( 5).
The avascular cartilage predisposes to poor healing of the penetrating placeholder or piece of jewelry with wound healing times of four months to one year and subsequent local infections. The incidence of complications in the auricle is 35 percent.
"In individual cases, local infections without purulent secretion are difficult to distinguish from allergic contact dermatitis," says Strieth (5). The allergic reaction, which can also manifest itself as a pigmentation disorder, should be treated with a skin ointment containing corticosteroids, and the uncomplicated local infection with a bactericidal ointment.
The current prevention campaign “Your skin. The most important 2 m2 of your life” from around 100 statutory health and accident insurance providers warns against risky body art. Photo: Mauritius Images
The current prevention campaign “Your skin. The most important 2 m2 of your life” from around 100 statutory health and accident insurance providers warns against risky body art. Photo: Mauritius Images
The risk of perichondritis abscess
The risk of perichondritis abscess is greatest within the first month after a piercing perforation, especially in the warm season. Most common pathogen: is Pseudomonas aeruginosa. In addition to antibiotic therapy, surgical treatment by an ENT doctor is indicated, says Strieth.
It could lead to permanent damage with partial necrosis of the ear cartilage and permanent deformation. Corresponding case reports, also from Germany, have been published (13). According to Strieth's experience, traumatic auricular tears usually occur as a result of sports and minor trauma. when the piercing is too close to the periphery (5).
Also with a nose piercing, for example in the area of the septum. the perforation of cartilage should be avoided because of the risk of perichondritis and abscess formation. According to the ENT doctor, the consequences of this can often only be treated with complex plastic reconstructions of the nasal septum.
Mouth area piercing
In the mouth area, the tongue is the most common location. It is usually perforated midline and just anterior to the insertion of the frenulum. Injuries to branches of the lingual artery can lead to severe bleeding and hematoma formation and even obstruction of the upper airways.
In the case of massive swelling of the tongue, intubation or a tracheostomy should be considered (5). In emergency situations like these, the piercing jewelry must be removed immediately, as is usually the case with less serious complications or when an operation is planned. Even with minimally invasive procedures, removal is desirable, if possible by the patient, says Kiechle.
Doctors should also familiarize themselves with the three main types of locking mechanisms. In an emergency, the jewelry can be destroyed. If the doctor removes it, written consent should be obtained if possible. The piece of jewelry should remain outside the body as long as the wound is not closed.
Belly button piercing
Some women put their belly button piercing back in immediately after waking up from the anesthetic of a laparoscopic procedure, against medical advice, Kielce’s experience (14). The increased risk of infection should be expressly pointed out. Patients often let weeks or months pass before they see a doctor if they have problems because they really want to keep the piercing. However, it is important to avoid condemning or discriminating against pierced patients.
People at significantly increased risk of complications include people with diabetes mellitus or whose immune system is compromised for other reasons (e.g., after organ transplantation, glucocorticoid therapy, or HIV infection), people with heart defects, a tendency to bleed, atopic dermatitis, or sacred (granuloma formation) ( 5, 8, 13).
Costs of treating complications
In any case, the costs of treating complications can be significant: they ranged from 3,000 to 4,300 euros for treatments after nipple abscesses (8).
Piercing is currently an unlicensed trade. There is no recognized training, a large proportion of piercers learn by watching and with the help of instructional videos.
"We have been campaigning for years, also in terms of consumer protection, to ensure that piercers become a recognized profession with standardized training and that clear and specific standard for certification and quality assurance are agreed with the authorities and monitoring of piercing studios," says Martina Lehn off, who founded the Academy for Percutaneous Body Jewelry in Cologne and the European Association for Professional Piercing. So far, this has not been implemented in any European country.
For the United States, the “Hospital and practice hygiene” working group of the Association of Scientific Societies published guidelines for hygiene piercing in 2000. However, in Lehn Hoff’s opinion - just like hygiene regulations in the federal states - they are not specific enough.
Many health authorities do not feel they have enough staff anyway to be able to monitor studios effectively. A query to the health department of a large German city revealed that on average those piercing studios that are known to the authorities can only be visited once every five years. But that is only a fraction.
Wound healing times
Facial area
Ear cartilage 4 months, 1 year
Earlobes 6–8 weeks
Tongue 4 weeks
Nasal septum 6–8 months
Nose wing 2–4 months
Bridge of the nose 8–10 weeks
Lips 2–3 months
Eyebrows 6–8 weeks
Trunk area
Navel 1–12 Months
Nipples 6–32 weeks
Genital area
External labia 4–10 weeks
Clitoral area 4–10 weeks
Penis 4–6 weeks
Sources: 5, 7
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