What Are the Signs of an Infected Body Piercing or Tattoo?

Richard S. Ferri, PhD, ANP, ACRN

Disclosures

November 30, 2010

Question

We see many people in our clinic with newly acquired tattoos and body piercings and are having a difficult time discerning if the artwork or jewelry is infected or just going through a "normal" healing process. Can you please provide some clinical insight?

Response from Richard S. Ferri, PhD, ANP, ACRN
Infectious Diseases Nurse Practitioner, Greater New Bedford Community Health Center, New Bedford, Massachusetts

Your question is very timely and right on the money. Tattooing and body piercing are now very common in the general population. According to a recent survey done by Harris Polls, 16% of all Americans have at least 1 tattoo.[1] Therefore, it is important for nurses and other clinicians to have better assessment skills in separating infection from healing issues.

First, it is important to remember that although both piercing and tattoos are invasive, they are probably not done by medical professionals but by tattoo or body-piercing artists. However, virtually all states have very strict and detailed requirements for the artist and the studio to follow with respect to aseptic technique, equipment sterilization, and universal precautions with appropriate medical waste disposal. These requirements can be found at your state's Department of State Health Services or Department of Public Health Web sites.

Body Jewelry

Body jewelry is somewhat more straightforward than tattooing. Body piercing is a form of body modification, achieved by inserting a piece of jewelry through the skin virtually anywhere on the body from the ear lobe to the penis. After the piercing site is cleansed, a sterile piercing needle is rapidly inserted through the body part and the jewelry is then threaded into place. Typically, the area is simply treated with topical antibiotic ointment, and specific and simple instructions are given to the person on how to care for the piercing for the next week or 10 days.

The site may appear very "angry," and red, and be tender for 48 or hours or so post-piercing, but remember that most piercings are not done with any topical anesthesia, so the reaction may be slightly more pronounced. However, any site that continues to redden, swell, and develop colored exudate should be considered suspicious and treated with an appropriate antibiotic, cleansing routine, and possible tetanus vaccine as indicated.

Genital piercings may be at increased risk for infection given their location, and if they do become infected, systemic infections can quickly follow. Nipple piercing is associated with subareolar breast abscess.[2]Piercing of the penis such as the Prince Albert piercing (vertical piercing from the outside of the penis up through the urethra) can cause blood in the urine after the procedure, and if a ring is worn, can interfere with a normal urine stream.

Tattoos

Body art ("ink") is a little more complicated, because the skin is subjected to hundreds to thousands of fine needle insertions by a tattoo machine, which introduces very small amounts of various pigments (colored ink) into the skin in the form of design that the person and their artist have agreed upon.[3] The skin may be lubricated before and during the inking process with some petroleum jelly.

After the artwork is complete, the artist will generally gently cleanse the site and apply some additional antibiotic ointment and a clean dressing. The artist should also provide verbal and written aftercare instructions, depending on the size and body location of the art. During the next few days the tattoo site will become slightly swollen, may be a little tender (over-the-counter pain medication may be taken) and perhaps slightly weepy with clear drainage. If the drainage becomes "rank" and colored, it is important to assess for signs of infection such as fever, increased white blood cell count (if indicated), and other associated clinical symptoms such a pain, fatigue, and swollen lymph nodes adjacent to the site. Treat as indicated, and follow any state or local health ordinance about reporting infected body art to the appropriate health department.

Finally, it is important for clinicians to remember that the tattoo site will likely go through a "shedding process" for about a week or so (again, depending on the site and size of the ink) after the artwork is done. The skin will likely become scaly and flakey and this is a normal reaction to the repetitive skin piercing that was done with the tattooing process, and is normal. Patients should be instructed to keep the site clean, not to "pick" or "pop" any blisters or flakes, and to apply gentle cleansing with some basic liquid (not bar) soap and water. It is also recommended that the soap be free of any perfumes or dyes to assist with infection prevention. It is important to keep the inked site moisturized with some additional petroleum jelly and clean dressings as needed. Once the tattoo is completely healed, one of the best ways to keep the art work looking fresh and colorful is daily application of sunscreen with an SPF of 15 or higher. This is also an ideal teachable moment about skin cancer prevention.

Body art and jewelry have been around for centuries. Nurses are ideally placed to help people understand what these forms of body modification require and how to live with them in a healthy manner.

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