When four teenage girls in Anne Arundel County, Md., contracted a tough-to-treat bacterial skin infection last fall that landed two of them in the hospital, the county health department quickly zeroed in on the cause: their new body art.
"The common factor was ... these tattoos," says Elin Jones, a spokeswoman for the Anne Arundel County Department of Health.
The girls had picked up methicillin-resistant Staphylococcus aureus -- or MRSA -- from a local tattoo artist working out of his basement. MRSA, which can appear as pimples or boils, grows rapidly, resists common antibiotics, and can infect the blood and bones if left untreated -- not exactly a desired after-effect of having your body inked.
Yet, according to a county police spokesman, the tattoo artist had "violated no criminal laws."
That's probably because there were few laws to break.
Maryland, like many other states, doesn't license its body artists. The state has passed some laws pertaining to sterilization but doesn't require its body artists to undergo any formal training or prove actual knowledge of sterile practices or blood-borne diseases -- nor does it mandate inspections.
"You could do it from home," says Brenda Roup, a nurse consultant in infection control for the Maryland Department of Health and Mental Hygiene. "No one is looking over your shoulder."
The craze for tattoos, nose and tongue studs, and lip, tongue and belly-button rings has spawned a burgeoning body art industry that lawmakers can't quite keep up with. A Journal of the American Academy of Dermatology study released this week suggests that nearly half of 18- to 29-year olds have either a tattoo or piercing.
One reason so many young people are painting or piercing their bodies ... their idols do it. Stars such as Angelina Jolie, Pamela Anderson, Britney Spears, Johnny Depp, the Rock, and rappers 50 Cent and Eminem all have body art in common, as do sports superstars Shaquille O'Neal, Jason Giambi and English soccer star David Beckham.
"People are looking at sports and celebrities and want to affiliate themselves with that," says Terisa Green, author of "The Tattoo Encyclopedia" and "Ink." "All the top models have a little something on their ankle, so there's also a little bit of a fashion thing."
Despite the growing legions undergoing the repetitious prickings of the tattoo needle or the one-two punch of the pierce, many are surprised to learn just how scantily the body decorating industry is regulated.
"They think it's been taken care of," says Myrna Armstrong, a professor of nursing at Texas Tech Health Services Center, who has studied body art for 15 years.
Yet no federal laws govern any aspect of the business, and state efforts to codify health, safety and training standards have been limited and scattershot. The strength of the regulations varies widely across the country, and even within states, according to Armstrong.
Fewer than 10 states specify any requirements for training, apprenticeships or continuing education, according to Armstrong, who reviewed body art regulations for an article in the Journal of Environmental Health last year.