http://www.idph.state.ia.us/common/pdf/publications/piercing_report.pdf
COUNCIL OF SCIENTIFIC AND HEALTH ADVISORS
IOWA DEPARTMENT OF PUBLIC HEALTH
FINAL REPORT
SUBCOMMITTEE REPORT: Body Piercing
I. Summary of problem
A. Introduced by: Dr. Gleason
B. At what meeting: Dec. 15, 1999
C. Background: Legislation was being considered to regulate body piercing in Iowa.
D. Purpose of report: to describe and evaluate the health risks associated with body piercing, as
identified in the published literature. No primary data were collected.
E. Identify timeline: N/A
II. Available Evidence
It is estimated that as many as 80% of American women have pierced ears, and the trend for piercing of
other body sites is known to be increasing, especially among adolescents. Few reliable data on incidence
or prevalence of post-piercing complications in sites besides the earlobe are published but they are
assumed to be similar to those of the earlobe, with the possibility of greater severity and/or frequency for
sites more subject to microbial contamination, pressure, or trauma.
It appears that minor complications of earlobe piercing are common and major complications are rare.
Infectious complications are not well-documented, perhaps because they are usually self-resolving and
often not treated by health care providers. Introduction of infectious agents occurs either due to poor
piercing technique and contaminated instruments or to improper aftercare.
Although staphylococcus aureus is the most commonly reported organism recovered in cases of postpiercing
infections of the ear lobe, p. aeruginosa is commonly identified when the ear cartilage has been
pierced. More serious infections, sometimes life-threatening, have occurred due to the presence of group
A beta-hemolytic streptococci. Rare incidents of infection with tuberculosis and tetanus have been
reported due to ear piercing. There appears to be some association of ear piercing with risk of hepatitis,
but the evidence is not consistent across studies and the populations are very likely dissimilar to Iowa’s.
III. Research Sources
A. Literature review - A Medline search using the keyword and text words “body piercing” (no
limitations on date of publication) yielded 40 English language articles on body piercing for cosmetic
reasons, with eight review articles. An additional Medline search using the keyword and text words
“ear piercing” (no limitations on date of publication) yielded 97 English language citations. The
highest level of evidence was the case-control studies of ear piercing risks (five) and prevalence studies
of ear piercing risks (eight). Only two of the prevalence studies and none of the case-control studies
were conducted in the U.S.
The majority of articles about piercing of sites other than the earlobe were either case reports of
unusual medical complications of body piercing or commentaries on body piercing practices and
health risks, with no controlled experimental or population-based studies; there were four regional
cross-sectional studies on self-reported prevalence of piercing and post-piercing complications. The
COUNCIL OF SCIENTIFIC AND HEALTH ADVISORS
IOWA DEPARTMENT OF PUBLIC HEALTH
highest level of evidence regarding health risks of body piercing for sites besides the earlobe at this
time available appears to be literature reviews, with expert opinion provided by the authors.
B. Expert sources and testimony : NA
C. Other people/organizations looking at issue The Iowa Dental Association approved the following
resolution, May 8, 2000: "Be it resolved, that the Iowa Dental Association opposes intraoral and
perioral piercing for public health reasons."
D. What other states are doing - The health departments of the states with body piercing regulations
(Maine, Ohio, Oregon, Texas and Wisconsin) were contacted to determine whether there are any data
on effects of these regulations; none had tracked incidence of complications before or after
regulations were instituted.
E. Other: none
III. Conclusions and Recommendations
A. Conclusions
1. Since the importance of aseptic technique in reducing complications (primarily infection)
for any procedures piercing the skin is well-documented, it seems reasonable to extrapolate
that complications of body piercing would be reduced by use of aseptic technique as well.
It is also important to note that there are certain areas of the body that cannot be effectively
decontaminated, therefore, caution should be used about piercing these areas. This logic is the
basis of the conclusions of the authors of the existing literature reviews and commentaries, rather
than epidemiological data or evidence from experimental studies.
2. There is little evidence, other than anecdotal, of serious health problems arising from body
piercing. Serious risks of ear piercing (primarily hepatitis) have not been documented consistently
across studies, and the populations in which the studies were conducted may not be generalizable
to Iowa’s. Piercing body parts other than the ear lobe may have greater risks, but few data are
available to support this since body piercing is a recent trend in the U.S.
3. There is no evidence for or against the idea that restricting the age at which people may
obtain piercings has any effect on reducing complications. Although some authors suggest
that age restriction may actually increase the risk because it may motivate adolescents to do the
procedure at home under less than optimal conditions, no data are available to support this theory.
B. Recommendations
1. If body piercing is to occur, it is mandatory that aseptic technique be used to reduce infectious
complications. There are certain areas of the body that cannot be effectively decontaminated,
therefore, caution should be used about piercing these areas.
2. The IDPH should take steps to make the public aware of these recommendations, conclusions and
concerns.