Body Piercing Can Be Life-Threatening

Emergency medical technicians recently wheeled a 19-year-old woman who had stopped breathing from an overdose of a “date-rape drug” into a Salt Lake City hospital.

Doctors at LDS Hospital tried to put a breathing tube down her throat, but their path was blocked by three 1-inch-long metal stud barbells running along the length of her tongue.

“One doctor got to the point where he said, ‘If you have to rip her tongue, just do it,’” says Dr. Shari Welch, one of the doctors on the case.

“Eventually we got the tongue out of the way, but her body piercing could have cost her her life,” Welch says.

Infections and Removal Problems

These days, increasing numbers of people, from mainstream baby boomers to rebellious teenagers, are piercing their bodies in stranger and stranger places — tongues, navels, even their genitals. As a result, doctors are starting to see more of body piercing’s dark side: Infections from dirty puncture wounds now happen in one out of every five piercings. The jewelry is tearing the skin. And studs and baubles in unusual places can hinder doctors from administering emergency care.

Body-art lovers defend their freedom of expression, saying it’s the doctors who should learn how to remove the jewelry in life-threatening conditions. The majority of people, they point out, know how to take care of themselves with disinfectants and cleaning once they’ve been pierced.

Currently, 37 of the 50 states have legislation regulating the body-piercing industry, and piercing professionals believe the rest should follow suit.

Making a Statement

“Body piercing has been around since ancient times and isn’t going to go away,” says Pat McCarthy, president of the Association of Professional Piercers in Columbus, Ohio.

Piercing is fashionable because it allows people to be different, McCarthy says.

“We wear shoes and clothing to make a statement. Piercing does the same thing,” McCarthy says. “Unlike tattooing, it isn’t permanent, and someone always has the option of taking the jewelry out.”

Regardless of the professionalism of some piercing shops, other stores are marginal and people do not always take care of themselves properly after the procedure, doctors say. The majority of piercings will close up if the jewelry is removed and not replaced, but doctors say cosmetic consequences, such as skin dimpling, can remain.

In her survey of the medical literature, Welch found a 22 percent infection rate for body piercing overall and a 34 percent infection rate for cartilage piercing.

Susceptible Areas

Cartilage in the outer ear and the nose is susceptible to infection because the tissue does not have an adequate blood supply to bring immune cells from the body to help fight off infections, explains Dr. Joseph Adrian Tyndall, program director of emergency medicine residency at the Brooklyn Hospital Center in New York.

The tissue on the ear can die as a result of an infection, leaving an ugly scar, Tyndall says.

Dr. William Mallon, director of the emergency residency program at Los Angeles County/University of Southern California Hospital, says his doctors see an adverse reaction to piercing at least once a week. These include allergic reactions to the metals used and infections, especially in hairy areas. Oozing pus from bellybutton piercings is quite common, Mallon says.

Infections also occur due to bacteria in the saliva of partners licking or biting a piercing that is healing. “People who pierce nipples or genitalia can be anxious to have their partner start sucking or biting it without waiting for the skin to heal as the piercers will recommend,” says Mallon.

“What happens with these patients is that they will come into the ER with an infection in these areas and we give them an antibiotic to usually the streptococcus or staphylococcus bacteria [on skin.] But the antibiotics won’t help because they needed an antibiotic that could fight the [gram negative] bacteria found in the mouth.”

At that point, they usually need to be hospitalized, he says.

An 18-year-old woman who came to the emergency room at LDS Hospital 15 months ago died from overwhelming infection caused by bacteria in a tongue piercing in her own mouth, Welch says.

In another LDS case, a 19-year-old man who had had his penis pierced suffered from his body art when he was in a car accident. The stud extended through the tip of the penis and crossed over his urethra, the tube that allows urine to pass from the body. The trauma of the accident dislodged the stud and now the young man occasionally has to go to the hospital for assistance with a catheter to urinate.

John Marx, chairman of the department of emergency medicine at the Carolinas Medical Center in Charlotte, N.C., says the most dramatic piercing problem he has seen is ripped skin from the jewelry either catching on clothing or from a lover pulling off a nipple ring in a fight.

Proper Care Key, Say Piercers

Piercing proponents pooh-pooh what they call doctors’s scare tactics. Roland Guiran, 24, who works in Cutting Edge Graphics in New York’s Greenwich Village, says he has pierced his penis and his ears. He also “stretches” his ears to hold cylinders of three diameters: one a half-inch; another five-eighths of an inch, and the third three-quarters of an inch.

“I enjoy it and have not really had a problem with infection,” Guiran says. “If you take care of piercing, it will take care of you.”

Each of the pierced body parts requires a different type of care, he says, and the shop provides a list of instructions. For oral piercings, for instance, the piercing association recommends an alcohol-free antimicrobial mouth rinse, such as Tech 200 or Biotene. Alcohol is not recommended because it increases the possibility of bleeding. Topical antibiotic creams should not be used for skin piercing because they prevent oxygen from reaching the wound to help it heal.

The Association of Professional Piercers’ McCarthy says only certain materials should be used in piercing, including a titanium metal known as Ti6A14V ELI, a surgical steel known as 316 LVMF 138, 14-karat and 18-karat gold, and a low-porosity plastic called Tygon or PTFE. Sterling silver should be avoided because it oxidizes.

Piercers Reaching Out to Doctors

To help educate the medical professionals about body piercing, McCarthy will be releasing a video at the annual meeting of the American Public Health Association, being held in Boston in November. A study last year from the Journal of Accident and Emergency Medicine found that only six of 28 ER doctors questioned knew how to remove different types of jewelry common to body piercing. McCarthy also will be offering a workshop about whether piercing studios pose a health risk.

Although consumers often sign consent forms before they undergo piercings — usually so owners can protect themselves from liability — Welch says the stores are not telling them everything they need to know.

“There should be better credentialing of the people performing these procedures or perhaps paramedics or nurse practitioners actually doing them,” Welch says. “People would probably not be letting themselves get pierced if they really knew the extent of the potential problems.”