Some states require only that anyone under the age of 18 obtain parental consent before getting pierced or tattooed. "That's often the only part of the regulations that gets implemented," says Jim Weber, who works on legislative issues for the Association of Professional Piercers and co-owns Infintite Body Piercing in Philadelphia.
Only about 19 states require a course in universal precautions -- a set of steps prescribed by the Centers for Disease Control and Prevention -- to prevent cross-contamination and transmission of blood-borne bacteria and viruses, such as hepatitis, tetanus and HIV. A handful require a course in sterile technique; and two call for courses in anatomy and physiology.
"There aren't enough regulations around body art," says Dr. Jeff Morehouse, chairman of cosmetic and reconstructive surgery at Lovelace Health Systems in Albuquerque, N.M., who lectures frequently on anatomy at body-piercing conventions. "There's no sort of certification you need to go through to become a body piercer."
Medical professionals generally agree that life-and-death complications arising from body art -- such as septicemia, endocarditis, toxic shock -- are rare, especially considering the large numbers of people getting pierced or tattooed every day.
"The complications I've seen are less related to the piercings themselves than to poor healing or how people take care of them," says Morehouse.
Still, experts warn, any breaking of the skin brings risk, especially in the absence of mandated safety and hygiene protocols. "Body art is an invasive procedure. You have a hole. You have a portal for infection," says Armstrong.
According to the recently released Journal of American Dermatology study, nearly one in four people surveyed reported medical complications -- including skin infections -- from piercings, and 13 percent reported problems with tattoos.
"Different sorts of piercings, when they're put in by people who don't understand or do a lot of piercings, can become a problem," Morehouse says, "particularly some of the genital piercings, where you can end up with nerve injuries."
Tongue piercings can also give trouble. The jewelry can crack, chip or knock out teeth, and cause gums to recede. The tongue can swell to the extent that it interferes with breathing.
State legislators haven't necessarily sat out the body art revolution, oblivious to its potential dangers.
"A lot of states have been looking at regulations for the last two or three years," says Weber, with attention sometimes piqued by the resurrection of such ancient practices as scarification and branding, tongue-splitting and skin suspension.
Pennsylvania, for example, introduces legislation almost every year. "It's just never voted on," says Richard McGarvey, a spokesman for the Pennsylvania Department of Health.
Body art bills also died this year in Minnesota and Washington state.
"Many states have tabled legislation," says Weber. "They simply don't have the funding to look at it right now." New York passed laws in 2004 but didn't allocate the dollars to give them regulatory teeth.
As it turns out, some of the biggest advocates for tighter regulations are the body artists themselves, eager to come out of the shadows and gain respectability.
"It's important for us to come forward and present our industry with the degree of professionalism a lot of people might not normally associate with us," says Troy Amundson, a body piercer at Apocalypse Tattoo in Seattle.