Vignettes from Adolescent Practice Piercings and Pearls Patricia

Vignettes from Adolescent Practice Piercings and Pearls Patricia J. Kelly, MD Adolescent Medicine Marshall University School of Medicine June 2012

Piercings and Pearls OBJECTIVES ◦ Anticipatory guidance ◦ Mainstream vs risky behaviors ◦ Medical complications ◦ “Asking permission”

Vignettes from practice. Got skin… …will pierce

Sports PE: 14 yo ♀ Fashion? Risky Behavior?

Piercings: Body Art Earlobe very common accepted mainstream Body piercings (other than earlobe) High schoolers: 10 to 33% College students: ∼ 50% 2004 Phone Survey 18 to 50 yo 1 st body piercing: < age 18

Anticipatory Guidance Piercing care? Contemplation? Relevant ◦ Physical activities ◦ Medical conditions Regrets ◦ 13 -18% removed Disappointed Bored Parents Social reactions www. youngwomenshealth. org

Anticipatory Guidance: Medical Conditions Diabetes Congenital Heart Obesity Autoimmune disorders Systemic Steroids … “Nickel” sensitivities Dermatitis ◦ Atopic ◦ Sebopsoriasis Keloids ◦ Patient history ◦ Family hx

Piercing: Jewelry Selection Surgical (Implant) grade stainless steel Niobium Titanium high polish Gold 18 K Solid Platinum Teflon/nylon

Piercings: General Aftercare � Saline Solution � Antibacterial soap ∅ alcohol ∅ hydrogen peroxide ∅ ointment � Wash X 2 day Remove crusts Rinse Dry: paper towel Wash Hands Avoid friction/trauma Avoid pools/hot tubs Rinse after excercising Keep jewelry in place until healed Signs of infection see health care provider Keep area clean

Naval piercing: Aftercare Infection Prone ◦ ◦ Moist Slow Healing 4 -12 mo Staph Fungal Clean clothes Soft fabric Loose fitting ◦ ∅ belts ◦ ∅ tights Migration ◦ Pregnancy Jewelry ◦ “fixed” ◦ Curved barbell Rinse after excercise

Oral piercings: Aftercare Oral piercings ◦ Rinse Antibacterial Alcohol free Saline Dilute peroxide ◦ New soft toothbrush ◦ ∅ Kissing/oral sex 4 -6 wks/healed ◦ Check for loose parts No Smoking

Nipple Piercings: Aftercare Clean clothes Soft fabric Snug shirt Sports bra Rinse p excercise

Sports PE: 14 yo ♀ Mainstream? Or Risky Fashion Behavior? Expression

Piercings: What’s the Motivation Fashion Statement Self Identity Peer acceptance Group membership Sensual pleasure Self Injury

Body Piercing: Risky Behavior? 50% good students Similar to peers ◦ Parental education ◦ Family relationships ◦ Religion involvement More Colorful… cross section of society!

Risk Taking Behavior Substance Use Sexual Activity Binge Drinking Defiant behavior Gang membership Anger Depression Suicidal Risky behaviors…. Cluster…

Piercing: “Trends” and Red Flags? Trends ◦ Female > male ◦ Naval: Female ◦ Nipple: Male Red Flags? ◦ ◦ ◦ Younger age Tattoos Cutting Burns Ear cartilage: gateway? Parents Friends

Variety…

Sports PE: 14 yo ♂ Self Identity? Group Membership?

Sports PE: 14 yo ♀ Meltzer. AFP 2005 Pocketing Gauge

Gauging… stretching Web instructions ◦ TOOLS ◦ JEWELRY ◦ SHOPS You Tube videos

The Pearls Asking Permission ◦ Would it be ok if I asked? Other piercings Other body art Get the story Paint the picture Exam the skin Respect MI: Self efficacy

16 yo ♂ with Dandruff Piercings Earlobe Gauge Cartilage Other sites? Contemplating Tattoos? Self injury? Rook Plug

Type 1 Diabetes: 15 yo Honor Student Asthma ◦ Intermittent ◦ Moderate Eyebrow piercing … migration

What’s next? Risky … … Fashion?

Piercing: Local Complications Infection Allergic (dermatitis) Keloids Bleeding (bruising) Tears Migration (rejection) Epidermal cyst

Ear Piercings: Cartilage Infection vs Dermatitis High rim cartilage ◦ Poor blood supply Pseudomonas ◦ Green drainage Perichondritis ◦ Acute tenderness ◦ Spares earlobe abscess necrosis

Body Piercing: Infections-complications Bacteria ◦ Staph ◦ Pseudomonas ◦ B strep Fungus ? Potential Tetanus Hepatitis B Hepatitis C ? HIV: no cases Complications Abscess Acute Glomerulonephritis Endocarditis Septic Arthritis Osteomyelitis Toxic Shock

Body Piercings: Management-Infections Warm Compresses Antibacterial Soap Antibiotics No topical ointments Leave jewelry in place ◦ Replace with temporary IV catheter ◦ Commercial removal kit

My daughter …. . Got her tongue pierced and it looks awful… Meltzer. AFP 2005 Long Bar Short bar

Oral Piercing: Complications Dental ◦ ◦ Duration of piercing Chipped/Cracked Tooth Gingival Injury/recession Root Canal Other ◦ ◦ Increased salivation Chewing/swallowing Speech Taste/numbness Infections Tongue piercings ◦ Staph ◦ Strep viridans Case reports ◦ Infective Endocarditis ◦ Ludwig’s Angina

Conclusions Mainstream ◦ Anticipatory Guidance ◦ Aftercare ◦ Risk taking behaviors ◦ Psychosocial problems Medical Complications Ask Permission Get the story Examine the skin Paint the Picture Body Art…… Alert Risky behavior….

References: Armstrong ML, De. Boer S, Cetta F. Infective endocarditis after body art: a review of the literature and concerns. J Adolesc Health. 2008; 43(3): 217 -225. Braverman PK. Body Art: piercing, tattooing, and scarification. Adolesc Med Clin. 2006; 17(3): 505 -519 Benjamins LJ, etal. Body Art among minority high school athletes: prevalence, interest and satisfaction; parental knowledge and consent. J Adolesc Health. 2006; 39(6): 933 -935. Carroll ST, etal. Tattoos and Body Piercings as indicators of adolescent risk-taking behaviors. Pediatrics. 2002; 109: 10211027. Hinz HA. Tattoos, body piercings, and self injury: is there a connection? Investigations on a core group of participants practicing body modification. Psychother Res. 2008; 18(3): 326333. Lane JE, Waller JL, Davis LS. Relationship between age of ear piercing and keloid formation. Pediatrics. 2005; 115: 1312 -1314. Larzo MR, Poe SG. Adverse consequences of Tattoos and Body Piercings. Pediatric Annals. 2006; 35(3): 187 -192.

References Laumann AE, Derick AJ. Tattoos and body piercings in the United States: a national data set. J AM Acad Dermatol. 2006; 55(3): 413421. Mayers LB, Chiffriller SH. Body Art (body piercing and tattooing) among undergraduate university students: “then and now”. J Adolesc Health. 2008; 42(2): 201 -203. Mayers LB, etal. Tattooing and Body Piercing. Pediatrics. 2003: 111: 1126 Meltzer DI. Complications of Body Piercing. American Family Physician. 2005; 72(10): 2029 -2034. Muensterer OJ. Temporary removal of naval piercing jewelry for surgery and imaging studies. Pediatrics. 2004; 114; e 384 -e 386. Navarro DS. What teens should know about oral piercings. School Nurse News. 2008; 25(5): 25 -26. Roberts TA, Ryan SA. Tattooing and High-Risk behavior in Adolescents. Pediatrics. 2002; 110: 1058 -1063. Schmidt RM, Armstrong ML. Tattooing and body piercing. Up. To. Date. ; www. uptodate. com