Henna and Hair Dye
Tattooing and body piercing are popular among adolescents—many of whom may not be aware of possible medical complications. Tattooing is associated with transmission of hepatitis B and C viruses. Although transmission of HIV is theoretically possible, no instances have been definitively proved.Body piercing also has been implicated in the transmission of hepatitis.
In addition to infection, pain, bleeding, and allergic reactions—particularly to the pigments used in tattoos—keloids and scarring can occur (as illustrated in the following photos). Keloid response to skin injury is genetically determined; these scars occur more frequently in those with darkly pigmented skin and are associated with piercing.
Staphylococcus aureus, group A ß-hemolytic streptococci, and Pseudomonas species have been isolated from post-piercing infections. These have the potential to become life-threatening infections.
Risks specific to oral piercing include gingival recession, gum tissue injury, chipped and cracked teeth, excessive saliva production, and tongue swelling. Tongue or lip studs that unfasten can become choking hazards. Oral piercings can also result in altered speech and chewing problems.
7 THINGS YOU CAN DO
1 Advise your patient of the complications that are often associated with tattooing and piercing. Many persons who opt for body art are unaware of potential health risks and sequelae.
2 Describe the procedures of tattooing and body piercing to your patient. He or she may not know that tattooing involves multiple intradermal injections to achieve the design's color and pattern.
3 Emphasize the need for these practices to be performed in a sanitary environment by trained personnel (Table).
4 Stress the importance of appropriate wound care and aftercare. Prepare patients for the healing time needed after their procedure.
Case and photo courtesy of CPT Erin Drifmeyer, MD, and COL Ken Batts, DO.
These children were treated with topical corticosteroids and oral antihistamines. The rash persisted in both
Case and photos courtesy of Angel Cadiz, MD.
5 Recommend the following care for new tattoos:
—Wash tattoos frequently with soap and water and apply antibiotic ointment for the first 2 to 3 days. Thereafter, keep the area clean and apply lotion to prevent drying and scabbing.
—Seek medical evaluation if skin redness or whitish drainage persists beyond the first few days.
—Do not rub or dislodge the scab that will form and remain for 1 to 2 weeks.
—Do not swim or use saunas or steam rooms until the area has healed.
—Apply sunblock to all exposed skin, including tattoos; sunlight fades the pigments.
This patient underwent carbon dioxide laser tattoo removal with good results.
Case and photo courtesy of Alan B. Schliftman, MD.
Bilateral Keloids Following
The keloid on the right ear was surgically excised after 4 months of triamcinolone acetonide injections.
6 Emphasize the following care for piercings:
—Select high-quality jewelry, such as rings and ornaments made from surgical steel, 14-carat gold, niobium, or titanium. Do not use jewelry made of nickel; a contact dermatitis can develop.
—Apply ice for swelling, if necessary.
--Do not allow pierced areas to come in contact with unclear hair, hands, clothing, or bed linens.
—Wash the area with antibacterial soap twice daily; rinse well; rotate jewelry; and dry the area thoroughly.
—Use antiseptic ointment for 1 week only; after eating, rinse oral piercings with mouthwash that does not contain alcohol(.
—Do not use alcohol, hydrogen peroxide(, or iodine( on the wound.
—Avoid public pools, hot tubs, spas, and the body fluids of others until the pierced area is completely healed.
—Expect redness and slight discharge for a few days. Seek medical evaluation if oozing pus, swelling, or crusting develops.
7 Educate your patient about tattoo removal procedures. Explain that today's fashion statement may be passe tomorrow and while laser surgery, dermabrasion, or excision can be tried, these modalities can be risky and may not be completely successful. *
Case and photos courtesy of Alan B. Schliftman, MD.