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BACKGROUND Piercings are body embellishments commonly seen in young people, however their inherent risk of infection and scarring disorders are less divulged. OBJECTIVE To evaluate the prevalence of body piercings among medical students and their possible dermatologic consequences. METHODS Cross-sectional study with 58 medical students, by means of a structured questionnaire covering socio-demographic characteristics, technical issues related to the piercing and characteristics of the dermatologic complications. RESULTS The sample was predominantly female (86.2%), with mean age 24 ± 3 years. The placement of the first piercing occurred during adolescence (median age 15), without medical supervision (91.4%) or knowledge of parents/guardians (74%). Most piercings were made of metal alloy/stainless steel, in a dumbbell model (51.7%), inserted in the umbilical area (53.5%) or ear (41.4%), with frequent cutaneous reactions in the first six months post-piercing. Hypertrophic scarring, pain, swelling and infection (p<0.05) had significantly higher frequencies among those with navel piercings. CONCLUSION Piercing insertion occurred during adolescence. Local inflammatory and infectious reactions were common. Scarring disorders and dermatitis appeared in the long term. There is need for preventive and educational activities, starting with those in the academic environment.
An Bras Dermatol. 2014;89(6):905-910.
Piercings in medical students and their effects on the skin*
Kátia Sheylla Malta Purim1,2 Bernardo Augusto Rosario1
Cristine Secco Rosario2Ana Tereza Bittencourt Guimarães2
Abstract: BACKGROUND: Piercings are body embellishments commonly seen in young people, however their inher-
ent risk of infection and scarring disorders are less divulged. OBJECTIVE: to evaluate the prevalence of body
piercings among medical students and their possible dermatologic consequences. METHODS: cross-sectional
study with 58 medical students, by means of a structured questionnaire covering socio-demographic characteris-
tics, technical issues related to the piercing and characteristics of the dermatologic complications. RESULTS: the
sample was predominantly female (86.2%), with mean age 24 ± 3 years. The placement of the first piercing
occurred during adolescence (median age 15), without medical supervision (91.4%) or knowledge of
parents/guardians (74%). Most piercings were made of metal alloy/stainless steel, in a dumbbell model (51.7%),
inserted in the umbilical area (53.5%) or ear (41.4%), with frequent cutaneous reactions in the first six months post-
piercing. Hypertrophic scarring, pain, swelling and infection (p<0.05) had significantly higher frequencies among
those with navel piercings. CONCLUSION: piercing insertion occurred during adolescence. Local inflammatory
and infectious reactions were common. Scarring disorders and dermatitis appeared in the long term. There is need
for preventive and educational activities, starting with those in the academic environment.
Keywords: Body piercing; Medical students; Scarring
Received on 17.06 .2013.
Approved by the Advisory Board and accepted for publication on 07.12.2013.
* Work performed at Universidade Positivo (UP) in association with Universidade Federal do Paraná (UFPR) – Curitiba (PR), Brazil.
Conflict of interest: None
Financial funding: None
1Universidade Positivo (UP) – Curitiba (PR), Brazil.
2Universidade Federal do Paraná (UFPR) – Curitiba (PR), Brazil.
©2014 by Anais Brasileiros de Dermatologia
For the last decades, the popularity of body
piercings has been in expansion in many countries,
socioeconomic strata and age groups, with prevalence
rates ranging from 25% to 51% among adolescents and
young adults.1-6 In ancient civilizations this accessory
entailed military, religious and socio-cultural issues,
having sparked prejudice due to a possible association
with signs of rebellion and risk behaviors.7-10 Currently,
its wear is motivated by several factors, mainly the
desire to try something new in order to take control of
the body and identity, but also by passing trends or
fads, influence of friends, inclusion into specific
groups, greater acceptance in society and the stimuli
provided by the media.1,2,11,12
The word “piercing” derives from the English
verb “to pierce”, which means to transfix and this is a
deliberate and somewhat semi-permanent procedure,
considered a factor that causes alteration of local
homeostasis and exposure to communicable dis-
eases.2,13 The risks to piercing wearers are grouped into
categories associated with purchase, possession and
health care.14 The risk stemming from purchase is
related to piece’s price and the procedure that the
individual undergoes to have it inserted.1,6,14 As to pos-
session, although the embellishment has a symbolic
value to the owner, others may perceive that body
symbol in a negative way, with impacts on relation-
ships and self-esteem.7,9,10,12,15 However, attention to
health risks is a priority due to the necessity to reduce
lesions, increase protection and prevent eventual
physical, emotional and cosmetic damages.12,14,15
Depending on the body region, manner of
insertion and maintenance conditions, the presence of
a piercing can justify disorders and adverse effects
that may go on for days, weeks or months after
implantation.1,6,8 The cutaneous areas that are most
reaction-prone are the navel, ear and nose.1,14 Studies
have demonstrated the occurrence of cutaneous infec-
tions, cysts, edema, granuloma, hematoma, keloids,
hypertrophic scars, abscesses, contact dermatitis and
allergic reactions.6,16,17 In intra and perioral regions,
research evidences: pain, edema, airway obstruction,
grooved or fractured teeth, gingival trauma, tongue
and lip injuries, interference with mastication, speech
and salivation, halitosis, periodontitis and foreign
body aspiration.18-20 Medical reports of piercing com-
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An Bras Dermatol. 2014;89(6):905-910.
plications in the pinna include perichondritis, cauli-
flower deformity, infectious disorders, scarring and
various aesthetic deformities.14,20 Studies also draw
attention to possible systemic outcomes such as bacte-
rial endocarditis, tetanus, hepatitis B and C, tubercu-
losis, HIV infection, toxic shock syndrome,
osteomyelitis and acute diffuse glomerulonephritis in
susceptible individuals.21-28
The detrimental aspects of piercing are associat-
ed with the lack of knowledge on preventive meas-
ures. Body piercing requires universal health precau-
tions and appropriate positioning, in restricted non-
cartilaginous areas.29-32 The decorative piece should be
made of surgical stainless steel, gold, titanium or
acrylic and regardless of the chosen type, it needs to
be removable to be periodically cleansed.1,2,18
Approximately 10-30% of piercing cases present infec-
tion or bleeding in the insertion site.1,19,31,33 These
adornments are contraindicated in pregnant women,
immunocompromised patients, those who are prone
to keloid formation, infectious dermatitis, atopic der-
matitis, and dermographism and also during sports
practice.1,18,33 Piercings are not recommended to
patients with blood dyscrasias, congenital heart dis-
ease and those using anticoagulants.1Individuals with
piercings, which were implanted in safe sanitary con-
ditions, must wait at least six months to donate blood.1
Current law establishes regulations and periodic
inspections of tattoo and piercing establishments. 1
Nevertheless, there is not yet a federal legislation
about the insertion of these body adornments in chil-
dren and adolescents.18
Despite frequent patients’ complaints on cuta-
neous reactions and scarring secondary to piercing
wear, we realize the need for more research to divulge
the risks involved in this practice. This knowledge is
important in the medical environment because such sit-
uations can have serious physical and emotional conse-
quences, and require specific approaches for their pre-
vention and treatment.1,29,32-35 The aim of this study is to
evaluate the prevalence of cutaneous piercing and the
ensuing consequences among young medical students.
This study is a descriptive cross sectional sur-
vey research, targeting the population of medical stu-
dents in a private institution in southern Brazil. The
research ethics committee approved this project (pro-
tocol number 041/2011) and assured confidentiality
and anonymity to the volunteers.
Piercing was defined as any type of adornment
(body piercing), jewelry, accessory or decorative
piece, inserted in the skin or mucosae, through a prob-
ing object (gun, needle, pin, ornament itself, piercing
stylus etc.), in different parts of the body other than
the earlobes. Ornaments in the second earlobe orifice
or the use of earlobe stretching plugs were not consid-
ered as piercings.
Assessment of tobacco consumption followed the
World Health Organization (WHO) criteria. The empha-
sis on tobacco was due to its important role in skin heal-
ing, with those having smoked a minimum of five packs
or 100 cigarettes during their lifetimes defined as smok-
ers, and those who meet the definition of a smoker, but
were not current users, as former smokers.
Physical activity was defined according to
World Health Organization (WHO) criteria as the
completion of at least 30 minutes of moderate intensi-
ty exercise on most days of the week.
Sample selection was non-probabilistic, by con-
venience and occurred through detailed explanations
about the research. We initially approached 161 stu-
dents of both genders and of any color/race/ethnici-
ty, between classes in the university hospital between
February and March 2012, on the daily wear of pierc-
ings. Those who answered affirmatively were asked
to participate in an assessment and screening session
for the study. We included 58 volunteers over 18 years
old, who had regularly worn piercing for more than
six months and agreed to participate by signing the
term of free and informed consent, according to
Resolution 196/96.
Data were collected through a structured ques-
tionnaire, pre-tested by three professors of medicine
and applied as a pilot in five students. This data col-
lection instrument was comprised of closed questions
to check the students’ sociodemographic features such
as gender, age, ethnicity, marital status, and behav-
ioral and health aspects, including immunization cov-
erage; and technical issues regarding piercings (type,
location, quantity, hygiene procedures). To verify the
complications and medical treatments secondary to
the piercing procedure, we used clinical and cuta-
neous data recall, medical history and physical exam-
ination. After data collection and assessment, students
were informed about preventive measures regarding
infections and dermatoses.
The results were analyzed using descriptive
statistics, according to the nature of the evaluated
variables. Quantitative variables were expressed as
means and standard deviations, and categorical vari-
ables using absolute and relative frequencies. The
absolute frequencies of skin lesions’ categorical vari-
ables in the different anatomical locations (ear, navel
and others) were compared between piercing wearers
through the Chi-Square Test for k proportions, fol-
lowed by multiple comparisons between analyzed
category frequencies by the Marascuilo procedure.
The duration of lesions was compared between the
groups that worn piercings on ears, navel, ears +
906 Purim KSM, Rosario BA, Rosario CS, Guimarães ATB
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An Bras Dermatol. 2014;89(6):905-910.
Piercings in medical students and their effects on the skin 907
navel and other sites by variance analysis for a single
factor. In all analyzes, we used the significance level of
p <0.05. These categorical variables were expressed in
cross tables and, when necessary, by column charts.
All statistical analyzes were performed using the sta-
tistical program XLStat2010.
The sample consisted of 58 students of a private
medical institution, who had worn piercings regular-
ly for more than six months. The average age of stu-
dents was 24 ± 3 years; eight were males (13.8%) and
50 females (86.2%). There was a predominance of
Caucasians (76.8%), singles (96.6%) and those enrolled
in the course’s 6th or 7th semesters (51.7%), (Table 1).
Regarding health features, eight students
(13.8%) had diagnoses of chronic illnesses (asthma,
hypothyroidism, rhinitis, epilepsy, myopia, polycystic
ovarian syndrome, migraine, psoriasis and depres-
sion), and 29 (50%) were taking medications daily,
especially contraceptives among women (38%) and
anti-inflammatory drugs in both genders (16%).
Forty-eight students (82.8%) were up-to-date with
their basic immunization schedule.
As for lifestyle characteristics, six students were
smokers (10.3%); four of these (66.6%) had been smok-
ing for a period 1-5 years and two (33.3%) smoked more
than ten cigarettes per day. Among the subjects ana-
lyzed, 27 (46.6%) practiced physical exercises regularly,
85.2% of them exercised three or more times per week.
Assessment of piercing wear characteristics
found that, on average, the first adornment was
implanted at 14±3 years of age, for reasons such as
fashion trend (44.8%) or willingness to experiment
(25.9%). The minimum age for piercing insertion was
12 years old, maximum of 23 years and median of 15
years. Thirteen students (22.4%) inserted another
piercing about a year after the first procedure. The
amount of body piercings was one to two (84.2%),
with a preference for metal/stainless steel piercings,
in dumbbell shape (51.7%) located in the navel (53.5%)
or ear (41.4%), (Table 2).
About the decision-making process on the pierc-
ing insertion, 29 (50%) students did not seek any infor-
mation, twenty (34.5%) sought information on the
Internet, thirteen (22.4%) talked about the question
with friends and five (8.6%) requested information
from physicians. Fifteen students (26%) did not discuss
the insertion with their parents before the procedure.
In assessing the characteristics of insertion pro-
cedures, data showed that body piercing was per-
formed in specialized studios (84.5%), with qualified
professionals (63.8%). Among the participants in the
sample, 27 completed a registration form on the use of
piercing (46.6%) and 32 received leaflets (54.4%).
Upon insertion of the piercing, the professional wore
gloves (94.8%), disposable materials (85.4%), topical
anesthetic (25.9%), and wound dressings (26.4%).
Variables Category FA FR%
Gender Feminine 50 86.2
Masculine 8 13.8
Age (years) 20 – 22 23 39.7
23 – 25 28 48.3
26 – 28 5 8.6
> 28 2 3.4
Race Yellow 3 5.2
White 43 74.1
Brown 10 17.2
Did not respond 2 3.4
Marital status Married/widow 2 3.4
Single 56 96.6
Origin Curitiba 29 50.9
Other cities in 16 28.1
Paraná State
Other cities in 12 21.1
other States
Which semester 2nd – 4th 5 8.6
are you attending? 5th - 6th 11 19.0
7th - 8th 27 46.6
11th - 12th 13 22.4
Did not respond 2 3.4
1: Absolute (FA) and relative frequencies (FR%) of socio-
demographic variables in a sample of piercing wearers (n=58)
Variables Category FA FR%
Reason Beauty 13 22.4
Influenced by friends 3 5.1
To record an event/time 2 3.4
Fashion trend 26 44.8
I wanted to 15 25.9
Material Silver 8 13.8
Metal/Stainless steel 47 81.0
Gold 8 13.8
Plastic 1 1.7
Model Ring 11 19.0
Dumbbells 30 51.7
Straight 14 24.1
Ball 8 13.8
Horseshoe 11 19.0
Site Mouth/lips 2 3.4
Tongue 5 8.6
Nipples 1 1.7
Ear 24 41.4
Navel 31 53.4
Nose 6 10.3
Perineal region 1 1.7
Eyebrow 2 3.4
Number of 1 35 60.3
pierced holes 2 13 22.4
3 or more 9 15.5
Did not respond 1 1.7
2: Absolute (FA) and relative frequencies (FR%) of varia-
bles about reason for wearing and piercing characteristics in the
sample (n=58)
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An Bras Dermatol. 2014;89(6):905-910.
908 Purim KSM, Rosario BA, Rosario CS, Guimarães ATB
Regarding hygiene habits, 33 students cleansed
the adornment daily (57.1%), 36 did not change the
piercing (61.4%) and one of the students changed it
daily (1.8%). Fifty-three students had worn the pierc-
ing for more than five years (91.4%). None of the 58
students in the sample had clinically apparent record
of systemic complications.
Assessment of cutaneous lesions secondary to
piercing wear showed that 29 students (50%) had local
reactions such as infections (55.2%),
pain/swelling/inflammation (37.9%) and hyper-
trophic scar/keloids (24.1%) in the first six months
after the insertion (65.5%), (Graph 1).
However, when evaluating the therapeutic
approach, we observed a spectrum ranging from no
intervention at all (41.4%), use of antibiotics (13.8%),
antiseptics (13.8%), and other ointments (10.3%), to
removal of the adornment (10.3%). Unsightly scars
(20%) and contact dermatitis (7.7%) also developed six
months after insertion, requiring specialized and pro-
longed treatment. In all insertion sites (ear, navel, ear
+ navel and others) the mean duration time of the
lesions was similar, ranging from 2 to 12 months (7 +5
months) (F 3,24=0.83, p=0.490) (Graph 2). Unwanted
scars were located mainly in ears and navel.
Comparisons between lesions arising in differ-
ent insertion sites demonstrated homogeneity in all
categories among piercing wearing groups (Table 3).
In this research, piercings were directly associ-
ated with adolescence, since all insertions occurred
prior to university admission. Adolescence is a stage
of human development, which includes biological,
psychological and social changes.1,3 The insertion of
such embellishments at this stage can be seen as a rite
of passage, a style, an ideology or a form of expres-
sion, with different understandings and interpreta-
tions according to the literature.9-12,15,31
Embellishments and body alterations are pres-
ent throughout the history of mankind and there are
several reasons for their practice in the contemporary
world.1,18 Among the main reasons to wear this acces-
sory are the expression of identity, followed by beau-
ty and fashion.1,11-13,18 In this study, we found that the
insertion of piercing was influenced by fashion trends
and the search for individual and collective affirma-
tion. The need for experimentation, as well as social
factors encouraging embellishment and consumption
may favor the decision to wear piercings, further
fueled by the industry and trade of body products.
GRAPH 1: Relative frequencies (FR%) of cutaneous lesions seconda-
ry to piercing wear in the first six months after the insertion
Infections Pain/edema/ Hypertrophic
inflammation scar/keloid
GRAPH 2: Mean duration of lesions secondary to piercing insertion
in different body regions
Ear Ear and Navel Navel Other
Duration of lesion (months)
Variable Category Ear Ear and navel Navel Other p
(n=16) (n=6) (n=29) (n=7)
Secondary lesion Allergy 2 12.5% 0 0% 2 13.3% 0 0% 0.627
Hypertrophic scar 2 12.5% 2 40% 4 26.7% 2 66.7% 0.53
Pain 3 18.8% 2 40% 4 26.7% 2 66.7% 0.63
Edema 3 18.8% 2 40% 4 26.7% 2 66.7% 0.639
Infection 3 18.8% 2 40% 9 60% 2 66.7% 0.825
Bleeding 1 6.3% 0 0% 0 0% 0 0% 0.445
Contact dermatitis 2 12.5% 0 0% 2 6.9% 0 0% 0.627
Unsightly scar 2 12.5% 2 33.3% 7 24.1% 1 14.3% 0.654
TABLE 3: Absolute (FA) and relative frequencies (FR%) of variables related to piercing insertion in different body parts
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An Bras Dermatol. 2014;89(6):905-910.
Piercings in medical students and their effects on the skin 909
In the present investigation, there was a preva-
lence of 58 (36%) piercing wearers among 161 students
that were approached. This result differs from the
studies performed with Portuguese (18%),
Venezuelan (28%) and American (51%) students,
which can be attributed to methodological, demo-
graphic and sociocultural variations.2,6,19 Only the
Portuguese study matched the characteristics of the
sample described here.19
The largest proportion of piercings among
females, although consistent with the literature1, can
be related in our research to the growing presence of
women in medical courses and the social expectation
on the maintenance of aesthetics and beauty stan-
dards12. The quantity of one to two perforations and
the preference for metal adornments was similar to
findings by other authors.1,6,16
The most widely used anatomical site for pierc-
ing insertion in the studies with Portuguese and
Venezuelan medical students was the pinna, whereas
in the present study, the navel region predominated.6,19
A likely explanation is the peculiarity of the Brazilian
social relations, which are expressed through the body
and physical appearance. Another reason is the
opportunity to show or conceal the existing embellish-
ment in the abdomen. The choice of the navel as a
location can still suggest the appraisal for a well-
formed and sensuous female figure.
Studies consider piercings as possible indica-
tors of situations involving smoking, alcohol and drug
abuse.7,11,12 In this study, daily smoking was observed
in three women and three men, with durations rang-
ing from 1-12 years. Two (33%) of these six students
had skin lesions secondary to the piercing insertion,
probably by the action of nicotine on the healing
process, in addition to constitutional factors.
Educational actions on protection and resilience were
suggested to prevent these young people to maintain
or initiate the smoking habit during university.
A research conducted on the detection of drug
abuse among Brazilian medical students indicated the
need to take preventive measures.34 In this study, we
did not specifically address the issue of alcohol and
illegal drugs, however, the tendency to over-medica-
tion verified among the students drew our attention.
On the one hand, the rational use of medications dur-
ing the medical training years can assist in the proper
management of patients afterwards, when these stu-
dents are practicing their profession. However, envi-
ronmental contamination with medication waste and
abuse of psychoactive drugs, are considered problems
of great magnitude nowadays.34
The priorities, in programs of integral attention to
youth and adolescents, are health promotion and dis-
ease prevention to minimize future consequences.1,19,32
Although wearing piercing is a personal choice, exag-
gerated body modifications should be observed with
caution, so that one can differentiate an identity crisis or
fashion fad from psychoaffective disorders.7,8,12,31 These
situations require ethical and sensible approaches, dis-
sociated from discriminatory perceptions, and aimed at
reinforcing dialogue and consolidating trust bonds.1
The lack of straightforward and specific
instructions on the risks of piercing wear exposes
individuals to the vulnerability of procedures per-
formed by unqualified personnel, which is a global
concern.6,12 Research shows that inadequate sanitation,
poor technique, inappropriate material and insertion
in areas subject to friction favor complications.25,26,29 In
the present study, infection and scarring disorders, as
well as pain and edema were frequent, especially in
individuals with navel piercings, but without statisti-
cally significant differences with other regions (p>
0.05). Such situations are likely to be influenced by the
foreign body presence; length of wound re-epithelial-
ization and friction caused by clothing.
Piercing materials containing nickel or chromi-
um may cause dermatitis by irritation or sensitization.
The individual, who insists on keeping the adornment
even with dermatitis, cannot however foresee the
development of hypersensitivity.35 In this investiga-
tion, a student had allergic sensitization to nickel con-
firmed by patch testing.
Unsightly scars, caused by the piercing procedure
with the purpose of making openings or holes to insert
jewelry in that space, can cause physical, social and psy-
chological discomfort.1,14 In this study, we observed that,
in twelve students (20.6%) the scarring disorders had
physical, psychosocial and economic consequences.
Since the use of piercing has become increasing-
ly frequent, physicians need to have correct informa-
tion and guidelines so they can warn and instruct
patients and treat conditions and consequences
imposed by bodily adornments. It is essential to have
the proper training to correct unsightly scars when the
patient wants to remove unwanted marks, as well as
dexterity to remove piercings, particularly intra-and
perioral, in case of complications and emergencies
such as traumas.1,18 By following the technical norms
of safe surgical practice standards, it is possible to pre-
vent potential exposure to contamination by secre-
tions or accidents related to the application of electro-
surgery in patients carrying metal objects.1,14
Notwithstanding the limitations of this study
regarding its design and sample size, this research
emphasizes the need to better educate the public, espe-
cially medical students, about the complications sec-
ondary to piercing wear.19,24,25 The importance of this
Revista6Vol89ingles_Layout 1 9/19/14 7:33 PM Página 909
work lies in finding that the decision to insert the
piercing occurred most often in an uninformed way, by
minors, without seeking medical guidance or parental
consent. Another important fact to stress is that this
type of procedure is not harmless, since it produces
local and systemic unwanted effects, as well as eco-
nomic and emotional costs. Preventive measures must
be known, understood and practiced systematically by
the subject and by all professionals involved before,
during and after the piercing insertion.
Facing all the potential problems that can be
generated by piercing wear, further investigations
with a larger number of participants and a control
group matched by gender and age, can provide infor-
mation to health professionals, parents, educators and
legislators to prioritize preventive measures and
improve the quality of care and conduct.
The prevalence of body piercing among these
medical students was high, especially in females.
Local complications were frequent and predominated
in the first six months after the procedure, especially
in those students with navel piercings. Infectious and
inflammatory processes marked the acute reactions,
while chronic reactions were related to scarring disor-
ders and contact dermatitis.q
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Porto, Portugal: Universidade Fernando Pessoa; 2011. 45p.
Kátia Sheylla Malta Purim
Universidade Positivo - Curso de Medicina
Rua Professor Pedro Viriato Parigot de Souza, 5300
Campo Comprido
81280-330 - Curitiba -PR
How to cite this article: Purim KSM, Rosario BA, Rosario CS, Guimarães ATB. Piercings in medical students and
their effects on the skin. An Bras Dermatol. 2014;89(6):905-10.
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Complication of nasal piercing by Staphylococcus aureus endocarditis: a case report
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decorative nose piercing: report of eight cases from eastern India. J Cutan Med Surg.
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in childhood. An Bras Dermatol. 2012;87:269-76.
An Bras Dermatol. 2014;89(6):905-910.
910 Purim KSM, Rosario BA, Rosario CS, Guimarães ATB
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... За результатами досліджень K.S. Purim із співавт. [4], при аналізі наслідків пірсингу у студентів-медиків та його дерматологічних ускладнень встановили, що у більшості випадків пірсинг був зроблений з нержавіючої сталі з подальшими шкірними реакціями у перші шість місяців після проколювання. Серед ускладнень пірсингу реєстрували гіпертрофічне рубцювання, біль, набряк та інфекцію. ...
... Одним з основних ускладнень цукрового діабету, який може призвести до інвалідизації хворих, є діабетична ретинопатія (ДР). [1,2,3,4,5,6], Під час розвитку цієї мікросудинної патології відбувається ураження судин сітківки із подальшим утворенням мікроаневризм, крововиливів та можливим новоутворенням судин на очному дні. І як наслідок цих патофізіологічних зрушень знижується гострота зору та розвивається сліпота [7, 8,9,10,11,12]. ...
... Рис.4. Гістологічні зміни ранового каналу язика та щоки на 60 добу після імплантації кліпси з медичної сталі: а -ознаки гнійного запалення в рановому каналі язика у ділянці відсутності епітелію та грануляційній тканині.б ...
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Introduction. In modern dentistry, medical steel, along with other materials used for dental implantation, is considered as biocompatible or bio-tolerant materials. Among the commonest complications caused by piercing, there are hypertrophic scarring, pain, swelling and infection. Therefore, the research on clinical and morphological changes in tongue and cheek tissues during experimental piercing with medical steel clips on animals and further evaluation of the consequences of this procedure seem to be quite relevant. The purpose of the study was to determine the effect of clips made of medical steel on the dynamics of the wound healing in tissues of the cheek and tongue following the implantation in test animals. Materials and methods. The experiment was conducted on the chinchilla line rabbits (n=8) in 2015. The animals were implanted with medical steel clips in soft tissue of the tongue and cheeks. Histological studies were performed on 7th, 14th, 28th and 60th days following the implantation to study the dynamics of the change in the pierced channel. Results and conclusions. The study has shown the purulent process in the tongue and cheeks tissues following the implantation of medical steel clips can be observed from the 7th to 60th days. Thus, we can suggest that the damaging effect of medical steel clips on tongue and cheek tissues in the test animal promotes purulent inflammation. The rabbits with implanted clips in the tongue and cheek had broad wound channels, containing purulent exudates, inflammatory infiltrates were found in the walls of the wound channel. During the experiment, the histological specimens of the cheeks and tongue showed a large amount of granulation tissue, signs of immaturity and secondary inflammation, slow transformation of granulation tissue into the connective tissue that causes a lack of complete epithelisation and promotes deep skin wounds. The impairment of nerve endings in the form of oedema of the endo- and perineuria as a consequence of the implantation of medical steel clips can be manifested by persistent pain syndrome, loss of local sensitivity and distortion of taste sensation. In future, we are planning to investigate the dynamics of the wound healing after intraoral implantation of clips made of other materials in the test animals.
... Today, oral piercing is widely popular, especially among teenagers and young adults [1]. Oral piercing often involves the lips, cheeks, tongue, uvula, or a combination of these sites [2,3], with the tongue and lips being the most commonly pierced sites [2]. ...
... To our knowledge, most studies on the use of metal jewelry for body piercing reported to date have focused on psychosocial, epidemiological, and clinical aspects [1,[3][4][5]. Interestingly, Lupi et al. [17] cytopathologically and chemico-physically analyzed the mucosa surrounding oral piercings to correlate results with adverse tissue signs. ...
... The increase in the prevalence of the use of metal jewelry for facial and oral piercing has spurred growing interest in reports of complications associated with their use [1,[3][4][5]. ...
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Objectives A group of adolescents with oral piercings was studied to determine the presence of metallic particles in cells exfoliated from the mucosa surrounding their metal oral piercings and the association between such particles and the metal jewelry, and to evaluate subsequent tissue implications. Materials and methods Sixteen teenage patients who had tongue and/or lip piercings were included. The clinical features of the oral mucosa and lip skin were evaluated. Exfoliative cytology was performed in the area surrounding the piercing. The surface of used and unused jewelry was studied by scanning electron microscopy and energy dispersive X-ray analysis. Results Hyperplastic, leukoedematous, and lichenoid lesions were observed in the mucosa, as well as lesions associated with metallosis of the lip skin. Cytological smears showed the presence of particles inside the epithelial cells; the particles were found to contain aluminum, tungsten, and molybdenum. In one case requiring surgical removal of the piercing, histological examination of the tissue associated with the piece of jewelry showed the presence particles containing aluminum, iron, and tin inside multinucleated giant cells. Although surface finish defects were observed on both unused and used piercing jewelry, they were more evident on the used pieces. Conclusions Ion particles are released from the metal piercings and could have been adjuvant factors in the development of the observed lesions. Cells exfoliated from the oral mucosa surrounding metal piercings may serve as bioindicators of corrosion processes. Clinical relevance We propose the use of exfoliative cytology to monitor corrosion processes and for routine clinical follow up.
... The tongue piercing is a highly popular form of this practice, surviving the always changing fashion waves. (1) It is the piercing that requires the most precision and knowledge regarding the placement technique, due to the highly vascularised constitution of the tongue, several technical errors are being registered throughout its popular years. The insertion of the jewellery in the tongue can be followed by multiple acute and chronic complications and literature describes numerous pathological issues following its practice. ...
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The practice of piercing the body’s different areas is a commonly observed form of body modification. It implies puncturing the skin tissue resulted in an opening, in which specific jewellery or an intradermal implant could be inserted. The tongue piercing is a highly popular form of this practice, but can be followed by multiple acute and chronic complications, such as bacterial and fungal infections. Our case describes the clinical situation of a 25 year old immunocompetent woman, who sought medical help after observing tissue abnormalities, following a newly inserted tongue piercing. We identified a correctly and professionally placed tongue jewellery associated with all clinical hallmarks of oral Candidiasis. Our aim was to microbiologically identify and treat the present yeast colonies.
Objective Body piercing is defined as the penetration of jewellery into openings made in different body areas. In the last decades, it has become increasingly common in the general population. The aim is to analyse the available literature about complications from body piercing for contributing to raise the awareness towards this issue and to plan and perform appropriate prevention interventions. Study design This is a systematic review. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to perform this systematic review; the protocol was registered with PROSPERO [CRD42020177972]. PubMed, Scopus and Web of Science were searched from database inception to April 2020, and articles in English language reporting a proven association between piercings and health risks were included, and their quality were assessed by adequate quality assessment tools. Results A total of 4748 studies were found, and after duplicates removal and screening, 84 articles were included. Studies dealing with microbiological effects reported these complications both locally and at distant sites as a result of the spreading of the primary site infection: mastitis, endocarditis, glomerulonephritis, cephalic tetanus, viral hepatitis, HIV, cerebellar brain abscess and toxic shock syndrome. In addition, bleeding, gingival recession, dental injuries, contact dermatitis, granulomatous dermatitis, keloid, fibroma and basal cell carcinoma were reported. Conclusions Health authorities should promote educational campaigns to spread the knowledge on health risks related to piercings. Besides, piercers are often not adequately aware of all the possible adverse effects due to piercings because their professional training differs among countries. It is therefore advisable to provide periodical upgrade of their education in this field.
Résumé Cette étude descriptive transversale et rétrospective a été réalisée avec un volet quantitatif et qualitatif sur les cicatrices pathologiques apparues après un deuxième piercing auriculaire à but esthétique dans une population négroïde de sexe féminin issue d’une zone endémique de chéloïdes. Sur une période de 10 ans (du 1er janvier 2010 au 31 décembre 2019), 172 patientes ont consulté pour des cicatrices pathologiques auriculaires après un deuxième piercing à but esthétique, dont 65,7 % d’étudiantes et 22,1 % d’élèves. Cliniquement, 143 patientes (83,1 %) présentaient des chéloïdes et 29 (16,9 %) des cicatrices hypertrophiques. L’âge moyen du deuxième piercing était de 22,62 ans ; 98 patientes (57 %) avaient des lésions uniques sur l’oreille percée et 74 (43 %) des lésions multiples ; 168 (97,7 %) n’avaient pas d’antécédents familiaux de cicatrices pathologiques. Nos patientes, originaires d’une zone endémique de chéloïdes, n’ont pas développé de cicatrices pathologiques lors du premier piercing dans l’enfance, mais en ont toutes présentées après le deuxième piercing. Plusieurs facteurs de risque peuvent être incriminés : hérédité, environnement, race, âge, genre, port de bijoux de mauvaise qualité, infection, dérèglement du processus de cicatrisation occasionné par le premier piercing, tension mécanique par le nouvel objet d’ornement. Mais aucune de ces hypothèses n’a pu être vérifiée. Au vu de ces résultats, nous déconseillons un deuxième piercing auriculaire à but esthétique chez les sujets négroïdes à risque, originaires des zones de forte endémie chéloïdienne.
Background: Microdermal implants are an increasingly popular form of body jewelry. The potential for electrical conduction burn at the site of metal jewelry left in situ during electrosurgery has prompted surgical societies to recommend routine removal before surgery. To date, however, there is a lack of evidence to support this practice. We assessed in vivo thermal effect and tissue damage around implants during and after electrocautery. Materials and methods: Stainless steel microdermal anchors were surgically implanted into four swine. After allowing for initial healing, negative controls were excised and evaluated. An electrocautery grounding pad was placed 2 cm caudal to the implant. Continuous electrocautery (coagulation/30 W) for 30 s was applied to the skin 2 cm cranial to the implant. Surface skin temperature was recorded during electrocautery using thermal imaging. Tissue damage was assessed by gross examination and histologic evaluation. The same procedure was then performed to the contralateral nonimplanted side as a sham control. Results: Electrocoagulation raised skin temperature around the electrocautery tip 27.7°C (Tmax 64.8°C). Skin temperature around the dermal implant rose 1.58°C (Tmax 38.6°C) compared with 2.03°C (Tmax 39.2°C) in the nonimplanted control skin (P = 0.627). Skin temperatures at implanted and control sites showed no statistical difference at any recorded time interval. Histologic review of excised tissue samples showed no evidence of thermal injury. Conclusions: Metallic implants appear to have no effect on skin temperature during the use of electrocautery even when in close proximity to both the electrocautery pen and return pad. Aggressive steps to remove microdermal implants before surgery may be unnecessary.
Body art has become increasingly popular resulting in the rising occurrence of adverse reactions; some of them are related to the procedures; other side effects are caused by the chemical substances. Nickel allergy is the most common complication of body piercing. The composition of tattoo and permanent Make-Up inks is complex. Besides a variety of inorganic and organic colorants, they contain impurities resulting from the production process of the pigments and a wide range of auxiliary ingredients. In order to identify the harmful agents, it is essential to know the exact composition of the materials. There is still a lack of knowledge about the biokinetics and metabolism of these substances and their impact on human health. More in particular there is a lot of concern about the safety of the pigments because their degradation in the skin leads to the formation of hazardous decomposition products. Although much work has been done to improve ink quality and safety, more research and epidemiological surveys are required. There is still a need of uniform worldwide regulation on the procedures and materials.
With the increasing popularity of body piercing, not only piercers but also healthcare professionals should be aware of the potential risks of this procedure and be able to recognize and handle complications. More in particular young adolescents represent a vulnerable group of customers. Risks of the procedure are bleeding, swelling, infection, and contact dermatitis caused by nickel allergy. Blood-borne diseases can be transmitted; granuloma, scarring, and keloid formation can occur. Oral piercings can damage the gums and teeth and interfere with medical interventions. Genital piercings can cause discomfort and even lead to sterility. Public awareness, good guidelines, and uniform regulation can help to minimize complications.
Tattoos, piercing, and scarification are now commonplace among adolescents and young adults. This first clinical report from the American Academy of Pediatrics on voluntary body modification will review the methods used to perform the modifications. Complications resulting from body modification methods, although not common, are discussed to provide the pediatrician with management information. Body modification will be contrasted with nonsuicidal self-injury. When available, information also is presented on societal perceptions of body modification.
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O uso de drogas entre estudantes universitários está cada dia mais difundido. Os índices de uso de álcool e drogas ilícitas podem ser maiores na população universitária do que na população em geral. OBJETIVO: Este trabalho procurou detectar quais são as drogas de abuso usadas pelos estudantes de medicina de universidade privada de Curitiba para posterior implementação de programa de prevenção secundária nesta população. MÉTODOS: Durante 106 dias, em 2006, foi aplicada adaptação virtual do questionário Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) aos 209 estudantes de medicina participantes do presente trabalho. RESULTADOS: Oitenta e oito (42%) estudantes participaram. A maioria era solteira (88%) e tinham entre 17 e 25 anos (85%). Setenta e oito por cento usou álcool pelo menos uma vez na vida. O uso na vida de tabaco foi de 39%; cannabis sativa 26%, inalantes 22% e estimulantes 11%. DISCUSSÃO: Os resultados encontrados são semelhantes aos de outras pesquisas em universidades e mostram alto número de usuários de drogas, especialmente o álcool. Essa é uma situação preocupante e aponta a importância da instituição educacional na prevenção da dependência química. CONCLUSÃO: O ambiente universitário influencia o uso de drogas e novas estratégias de prevenção são necessárias.
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Metals, especially nickel, are the most common contact allergens in children. Recent data has shown increased incidence of allergy in industrialized countries. Sensitization can occur at any age, even in neonates. Costume jewelry, particularly earrings, is linked to increased sensitization to nickel. Sensitization to cobalt often occurs by the use of costume jewelry. The most common source of sensitization to chromium is leather. Due to the absence of a specific therapy, the main treatment is to identify and avoid the responsible allergens. This article presents an updated view on the epidemiological and clinical aspects of contact allergy to metals, focusing on prevention strategies and risk factors, and warns about possible and new sources of contact.
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We aimed to investigate the association of psychopathology with tattooing and body piercing among adolescents in Istanbul by means of self-report questionnaires. Tenth, eleventh and twelfth grade students from 2 high schools in Istanbul with a total number of 607 participated in the study. The Youth Self Report, Children's Depression Inventory and a detailed semi-structured inquiry assessing tattooing, body piercing and some psychiatric and psychosocial variables were administered to the students. The prevalence of tattooing and body piercing were 4.8 and 7 %, respectively. The adolescents with tattooing and body piercing were found to have a higher frequency of alcohol and drug use, smoking, going to bars/night clubs and lower school grades when compared to those without tattooing and body piercing. Externalizing problems, mainly delinquent and aggressive behaviours were more prominent in the adolescents with tattooing and body piercing. Tattooing and body piercing in adolescents may be indicative of mental health risks.
Background Body piercing has become a common fashion trend globally, irrespective of social classes and age groups. Almost no external organ in the human body has escaped piercing. Nose piercing is a fairly common practice all over the world. A number of local and systemic complications (both infectious and noninfectious) may follow nose piercing. Piercing by nonprofessional or unskilled persons, use of nonsterile piercing instruments, and poor standards of hygiene in the care of the puncture site are the most important factors accountable for such complications. Objective and Conclusion We report here a case series of eight patients who presented with nasal granuloma pyogenicum following decorative nasal piercing to highlight a relatively rare but potentially serious complication of the procedure. The role of adopting appropriate sterile techniques for preventing such complication is emphasized.
Body and earlobe piercing are common practices in the USA today. Minor complications including infection and bleeding occur frequently and, although rare, major complications have been reported. Healthcare professionals should be cognizant of the medical consequences of body piercing. Complications vary depending on the body-piercing site, materials used, experience of the practitioner, hygiene regimens, and aftercare by the recipient. Localized infections are common. Systemic infections such as viral hepatitis and toxic shock syndrome and distant infections such as endocarditis and brain abscesses have been reported. Other general complications include allergic contact dermatitis (e.g. from nickel or latex), bleeding, scarring and keloid formation, nerve damage, and interference with medical procedures such as intubation and blood/organ donation. Site-specific complications have been reported. Oral piercings may lead to difficulty speaking and eating, excessive salivation, and dental problems. Oral and nasal piercings may be aspirated or become embedded, requiring surgical removal. Piercing tracts in the ear, nipple, and navel are prone to tearing. Galactorrhea may be caused by stimulation from a nipple piercing. Genital piercings may lead to infertility secondary to infection, and obstruction of the urethra secondary to scar formation. In men, priapism and fistula formation may occur. Women who are pregnant or breastfeeding and have a piercing or are considering obtaining one need to be aware of the rare complications that may affect them or their child. Though not a 'complication' per se, many studies have reported body piercing as a marker for high-risk behavior, psychopathologic symptoms, and anti-social personality traits. When it comes to piercing complications, prevention is the key. Body piercers should take a complete medical and social history to identify conditions that may predispose an individual to complications, and candidates should choose a qualified practitioner to perform their piercing. As body piercing continues to be popular, understanding the risks of the procedures as well as the medical and psychosocial implications of wearing piercing jewelry is important for the medical practitioner.
Backgraund: In order to change the outside appearance a great deal of resources are used, as jewelry, costumes, hair styles, the use of tattoos and body piercings, the last being more frequent mainly in adolescents and young adults.The late motive to make use of this means is diverse and in some cases it's also reason of adverse reactions. Objective: To analyze the demographic and clinical data of the users of body piercings and tattoos. To point out unwanted side effects related to them. Patients and method: This is a retrospective and descriptive study, in which clinical records piercings and/or tattoo users, coming from the outside patients service of dermatology from National Institute of Medical Sciences and Nutrition of Mexico, as well as private practice were reviewed in a two year period. Results: A total of 102 patients were studied, being 52 males and 50 females with a rank age of 14 to 58 years. The reason of application of piercings or tattoos was mainly to be in fashion. 25% developed unwanted side effects; eighteen because of piercings and nine secondary to tattoos. Only two cases had severe side effects; tongue and glottis edema and one systemic sarcoidosis. Conclusions: Secondary adverse reactions are relatively frequent in body piercings and/or tattoo users; it is less common this reaction is severe or fatal. Treatment cost of these side effects is certainly higher than their application.
Artículo original Dermatología Rev Mex 2009;53(5):219-24 REsUMEN Antecedentes: la aplicación de tatuajes y piercings se realiza con la finalidad de modificar el aspecto externo del individuo. Sus motivos son diversos y en algunos casos provocan reacciones adversas. Objetivo: analizar los datos demográficos y clínicos de pacientes con piercings y tatuajes, y destacar los efectos indeseables derivados de éstos. Pacientes y método: se efectuó un estudio descriptivo y retrospectivo; se revisaron los expedientes de pacientes con piercings o tatuajes, que acudieron a la consulta externa de Dermatología del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, y de la consulta privada, en un periodo de dos años. Resultados: se registraron 102 pacientes (52 hombres y 50 mujeres), con límites de edad de 14 a 58 años. El motivo de aplicación de piercings y tatuajes fue, principalmente, por moda. En 25% de los casos hubo eventos indeseables: 18 por piercings y nueve por tatuajes; sólo en dos casos fueron graves (edema severo de la lengua y la glotis y sarcoidosis sistémica). Conclusiones: las reacciones adversas por piercings y tatuajes aparecen con relativa frecuencia y, ocasionalmente, pueden ser graves; el costo del tratamiento por complicaciones es más alto que el que genera su aplicación. Palabras clave: piercings, tatuajes, reacciones adversas, edema de glotis, sarcoidosis.
This study aims to examine the prevalence and sociodemographics, family and peer correlates of tattooing among high school students in southern Taiwan, and to examine the associations between tattooing and a variety of adolescent risk-taking behaviors and depression. A total of 9755 high school students (grades 7 to 12) in southern Taiwan were recruited into this study and completed the questionnaires. The prevalence of tattooing among the adolescents was calculated. The responses were analyzed using the logistic regression analysis models. It was found that 1% of high school students in southern Taiwan had 1 or more tattoos on their bodies. The older students who were perceived to have low family monitoring and who had friends who drink regularly, used illicit drugs, had a criminal record or were in a gang were more likely to have a tattoo. Tattooing was also found to be associated with violence, weekly alcohol consumption, illicit drug use, dropping out of school, unprotected sex, suicidal ideation/attempt, and depression. The results indicate that several demographics, family and peer factors are associated with adolescent tattooing. Tattooing may be an indicator of risk-taking behaviors in high school students.
Body modifications such as piercings, tattoos and surgery have increased in popularity in recent times and have become more socially acceptable. The common complications of piercing different parts of the human anatomy are well-documented, including sepsis, allergic reactions and, more rarely, endocarditis and ischaemia. Deaths related to piercing complications are primarily septic in origin. In this case, a man in his 50s died due to complications of his multiple umbilical piercings. The cause of death was unusually linked to body modification; the umbilical piercings had ultimately led to a mesenteric infarction. Cases such as these are forensically important due to potential manslaughter charges that could be brought against a piercing establishment. More importantly, this case highlights another extreme complication of body modification. Fashion statements are always changing and impact upon many lives. It is important to highlight to people the potentially life-threatening complications of common piercing practices.
Background: Body piercing has become a common fashion trend globally, irrespective of social classes and age groups. Almost no external organ in the human body has escaped piercing. Nose piercing is a fairly common practice all over the world. A number of local and systemic complications (both infectious and noninfectious) may follow nose piercing. Piercing by nonprofessional or unskilled persons, use of nonsterile piercing instruments, and poor standards of hygiene in the care of the puncture site are the most important factors accountable for such complications. Objective and conclusion: We report here a case series of eight patients who presented with nasal granuloma pyogenicum following decorative nasal piercing to highlight a relatively rare but potentially serious complication of the procedure. The role of adopting appropriate sterile techniques for preventing such complication is emphasized.