Marcia Frellick

September 19, 2017

CHICAGO — In its first clinical report on tattoos and piercings, the American Academy of Pediatrics (AAP) offers guidance for physicians and parents on talking to adolescents about an increasingly common desire for body art.

The AAP report — Adolescent and Young Adult Tattooing, Piercing and Scarification — was developed to address the growing numbers of teens and young adults choosing body art.

About half of people 18 to 30 years of age have some kind of piercing or tattoo, said Cora Breuner, MD, a pediatrician at Seattle Children's Hospital, who is chair of the AAP committee on adolescence, which produced the report.

Physicians and parents should stress that tattoos are fairly permanent and removing them can be painful and expensive, the report suggests. Laser removal, which is not typically covered by insurance, can cost up to $600 for a 3-inch tattoo, Dr Breuner said.

Complications are rare, but people seeking tattoos or piercings should be up to date on all vaccinations, especially tetanus and hepatitis, according to the report. And people should be aware that immunosuppressants can interfere with the healing process after a tattoo or piercing.

Laws for consent differ by state, but 38 states have laws that ban body piercing and tattooing for minors without parental permission.

About half of people 18 to 30 years of age have some kind of piercing or tattoos.

The subject is important enough to ask whether a patient is considering a tattoo or piercing on the previsit checklist completed by the patient in the waiting room, she said. That will give the physician a jumping off point for conversations.

"Most pediatricians don't ask this in well-child visits," Dr Breuner pointed out here at the AAP 2017 National Conference.

Physicians should not see requests for tattoos or piercings as a form of nonsuicidal self-injury, she emphasized.

"It's a myth we want to dispel," Dr Breuner explained. "When you see someone with seven or eight piercings, it is not a cry for help."

It would have been nice if the report had more thoroughly addressed the psychologic motivations for body modification, said Marvin Belzer, MD, director of the division of adolescent medicine at Children's Hospital Los Angeles.

"It's not just nonsuicidal self-injury. Youth experiencing depression, anxiety, and mania may make choices they later regret," he told Medscape Medical News. "I typically ask youth to explain stories about their tattoos or piercings as an opening to assess whether they are thoughtful applications of body art or more impulsive reactions that might reflect mental health or substance abuse problems."

Allergic Reactions, Infection

With the increase in body modifications, physicians should know how to treat minor infections and allergic reactions related to the procedures, recognize serious infections, and refer appropriately, he explained.

"I find it interesting that the AAP has basically accepted the inevitable — that young people today are getting tattoos and piercings at higher rates," said Kevin Hopkins, MD, a craniofacial/plastic surgeon at Driscoll Children's Hospital in Corpus Christi, Texas.

The report will likely raise awareness among patients "of the very real possibility of complications with permanent sequelae," he pointed out.

Dr Hopkins explained that in his practice, they regularly see patients with piercings that have caused infections or keloids or that are embedded in subcutaneous tissues. "Less frequently, we will see an infection from a tattoo or get a request to have one removed."

This report could encourage physicians to get teens thinking about safe places to get the work done, and whether artists are licensed and proper protocols are in place, said Anne Laumann, MBChB, professor of dermatology at the Northwestern University Feinberg School of Medicine in Chicago.

She said that when she talks at high schools, she recommends making a list of the pros and cons of tattoos and piercings and then waiting a few months to gauge long-term interest.

Teens might also want to try a temporary or henna tattoo before committing to permanent ink, added Dr Breuner.

Physicians should address the social implications mentioned in the report, as well as the physical implications, Dr Laumann said. And they should help young patients think about the possible implications of body modifications for their future, such as the effect they could have on employment opportunities.

"It used to be taboo to talk about sexuality, or even feelings of sadness or anxiety, but now it's really mandatory that these be brought up," added Dr Breuner.

The hope is that, with the ubiquitous nature of tattoos and piercings, this report will help facilitate conversations between providers, parents, and patients in a similar manner, she told Medscape Medical News.

Dr Breuner, Dr Hopkins, Dr Laumann, and Dr Belzer have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2017 National Conference and Exhibition. Presented September 18, 2017.

Follow Medscape Pediatrics on Twitter @MedscapePeds and Marcia Frellick @mfrellick


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