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.