Question of the Week

April 12, 2004


Something new:

"AMSTERDAM (Reuters) - Body piercing and tattoos make way. The latest fashion trend to hit the Netherlands is eyeball jewelry. Dutch eye surgeons have implanted tiny pieces of jewelry called 'JewelEye' in the mucous membrane of the eyes of six women and one man in cosmetic surgery pioneered by an ophthalmic surgery research and development institute in Rotterdam. The procedure involves inserting a 3.5 mm (0.13 inch) wide 1 piece of specially developed jewelry -- the range includes a glittering half-moon or heart -- into the eye's mucous membrane under local anaesthetic at a cost of 500 to 1,000 euros ($1,232).... The piece of jewelry is inserted in the conjunctiva -- the mucous membrane lining the inner surface of the eyelids and front of the eyeball -- in sterile conditions using an operating microscope in a procedure taking about 15 minutes. 'Without doing any harm to the eye we can implant a jewel in the conjunctiva,' Melles said. 'So far we have not seen any side effects or complications and we don't expect any in the future.' The Rotterdam-based institute, which develops new ocular surgical techniques in corneal, cataract and retinal surgery, developed and patented the jewelry made with special materials and the surgical procedure."
(Visit the above link to view a JewelEye being modeled by one of the recipients.)

"under local sterile made with special materials...not seen any side effects or complications..." Please keep in mind that there have been no side affects on the seven (7) people who have tried this procedure in the short time since the implantations began; it is a good start.

Anesthetic, sterile conditions, and the material from which the jewelry is made are all important aspects to consider; these are aspects that are often not taken into consideration when people are considering tattoos, piercings, or other forms of body art. As for side effects:

"So Just How Bad Is the Piercing Scene? Well, the American Dental Association opposes oral (tongue, lip, or cheek) piercing and calls it a public health hazard.... And both the U.S. and Canadian Red Cross won't accept blood donations from anyone who has had a body piercing or tattoo within a year because both procedures can transmit dangerous blood-borne diseases. If you choose to have a body part pierced, you run the risk of the following:* Chronic infection * Prolonged bleeding * Scarring * Hepatitis B and C (which can be fatal) * Tetanus * HIV (although there are no documented cases of this) * Skin allergies to the jewelry that's used * Abscesses or boils (infected cysts that form under your skin at the site of the piercing, which you may have to have drained with needles) * Permanent holes in your nostril or eyebrow * Chipped or broken teeth * Choking from mouth jewelry * A speech impediment..."

All that just from a piercing or tattoo? Really?

"Piercing invades subcutaneous areas and has a high potential for infectious complications. The number of case reports of endocarditis associated with piercing is increasing. We studied a 25-year-old man with a pierced tongue, who arrived at Memorial Health University Medical Center with fever, chills, rigors, and shortness of breath of 6 days' duration and had an aortic valvuloplasty for correction of congenital aortic stenosis.... In the United States, body piercing, which is becoming increasingly common, is mainly performed by unlicenced practitioners. Only 26% of states have regulatory authority over tattooing establishments, and only six of these states exercise authority over body-piercing establishments. Piercing occurs in regulated and unregulated shops, department stores, jewelry shops, homes, or physicians‚ offices. Generally no antibiotic is used, and sterilization methods vary."

"The inks used in tattoos and permanent makeup (also known as micropigmentation) and the pigments in these inks are subject to FDA regulation as cosmetics and color additives. However, FDA has not attempted to regulate the use of tattoo inks and the pigments used in them and does not control the actual practice of tattooing. Rather, such matters have been handled through local laws and by local jurisdictions. But with the growth in popularity of tattooing and permanent makeup, FDA has begun taking a closer look at related safety questions. Among the issues under consideration are tattoo removal, adverse reactions to tattoo colors, and infections that result from tattooing. Another concern is the increasing variety of pigments and diluents being used in tattooing -- more than fifty different pigments and shades, and the list continues to grow. Although a number of color additives are approved for use in cosmetics, none is approved for injection into the skin. Using an unapproved color additive in a tattoo ink makes the ink adulterated. Many pigments used in tattoo inks are not approved for skin contact at all. Some are industrial grade colors that are suitable for printers' ink or automobile paint."

"Rather, such matters have been handled through local laws and by local jurisdictions."
"Only 26% of states have regulatory authority over tattooing establishments, and only six of these states exercise authority over body-piercing establishments."

What is happening in your state?

In Arizona:
"A. It is unlawful to intentionally brand, scarify, tattoo or pierce the body of a person who is under fourteen years of age. This subsection does not apply to ear piercing or procedures prescribed by a health care provider licensed pursuant to title 32.
B. It is unlawful to tattoo a person who is fourteen, fifteen, sixteen, seventeen or eighteen years of age without the physical presence of that person's parent or legal guardian.
C. It is unlawful for a person who tattoos or pierces the body of another person to use a needle or ink more than once or to use a needle that is not presterilized or autoclaved. D. It is unlawful for a person who is not licensed pursuant to title 32 to administer anesthesia during the course of any procedure involving the branding, scarifying, tattooing or piercing of the body of another person."

In Arkansas:
"Tattoo and permanent cosmetic artists are required to be certified in Arkansas. Certification requirements include a six-month apprenticeship with an artist who has been certified in Arkansas for a minimum of three years. An application for apprenticeship must be completed as well as a written exam which is based on the Rules and
Regulations Pertaining Permanent Cosmetic and Tattoo Establishments. A practical exam is conducted near the end of the six month apprenticeship....Act 414 of 2001 also addresses body piercing as a form of body art."

But not all the information coming out of the states is encouraging to the health community.

In Oregon,
"The Oregon Health Department investigated what caused at least seven people to get a severe infection following upper ear cartilage piercing. They discovered a jewelry stand in a rural Oregon mall was using unsanitary and out-of-date equipment. The infection that developed can be very serious. 'The ear looses its ability to hold its shape and so the ear kind of crinkles up and becomes quite unsightly. So it is a disfiguring infection. It doesn't affect your hearing, it doesn't affect long term health but cosmetically it is quite unfortunate.' Dr. Keene warns while piercing is common, it is still an invasive procedure. To cut down on infection people should look for places that have well-trained employees, updated equipment and a sanitary environment."

Some tattoo artists, and those who do piercings, may see the new regulations as more trouble than they are worth. These new regulations, however, are not just there to protect the consumer. The following site was created to help those performing the procedures:

"The purpose of this site is to help tattooists and body pierces to comply with the regulations by explaining how infection can be associated with procedures they employ and precautions they should take to protect their clients, themselves and the community....The potential for serious infection occurs during tattooing and body piercing. The needles that are used to penetrate the skin at various sites on the body can become contaminated by blood or serum. HIV (the virus which causes AIDS), Hepatitis B and Hepatitis C viruses are present in blood and spread by infected blood entering another person's bloodstream. This can happen during tattooing or body piercing, when needles used for penetrating the skin are contaminated with infected blood or serum and are not sterilized before use on another person. The person at risk may be the next client being treated with the contaminated instrument or you, if you accidentally penetrate your skin with the contaminated instrument. This is called a 'needle-stick' injury. Contact with infected blood, serum or contaminated instruments on open cuts, sores or broken skin can also lead to infection."

"Still Interested? ...[T]here are some things you can do to make piercing safer. Make sure the shop where you get your piercing:
* is clean
* avoids the use of piercing guns, which aren't sterile
* uses needles once and disposes of them in a special container
* sterilizes everything that comes near the customer in an autoclave (this is a sterilizing machine that hospitals use on their instruments)

In addition, the piercer should wear disposable gloves and a mask - which he or she changes with each customer. And if you do get pierced, make sure you take good care of the piercing afterward - don't pick or tug at it, keep the area clean with soap (not alcohol) and don't touch it without washing your hands first. If you have a mouth piercing, use antibacterial mouthwash after eating. So think long and hard before you get anything other than your ears pierced. Most importantly - don't pierce yourself or have a friend do it - it doesn't get much less sterile than your bedroom on a Friday night."

If you are under tha age of eighteen (18) and considering a tattoo or a piercing, please consider: Anyone who is willing to "look the other way" and ignore the fact that you are a minor, may be "looking the other way" on some of these health and safety regulations, as well. Call around. Check with the Department of Health.

Questions of the week:
What laws and regulations (if any) are in place where you live? What information should people have about the health issues associated with tattooing, piercing, branding, etc. before they make a decision about whether or not it is something they want to do? Once the decision has been made, what questions should the prospective clients ask of any person and/or place of business where they are considering having the work done? If no regulations exist where you live, is it possible to assure a safe procedure? If regulations do exist, is it possible to assure a safe procedure? What health risks change when safety precautions are taken? What risks are the same in either location?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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