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Rick decided to get a tattoo and nose piercing because he thought they would look cool. After all, several rock stars have them–and they sure look cool. But the local piercing and tattoo shop operators weren’t following health regulations. They weren’t sterilizing their equipment correctly. And Rick just happened to be the unlucky guy who picked up a hepatitis C infection from a contaminated needle. Now he’s stuck with this debilitating disease for the rest of his life, and he will probably need a liver transplant to survive at all.

Tattoos and body piercings seem to be everywhere these days. According to Launchscore.com, a startup planning and information site for new entrepreneurs, Tattoo parlors are in great demand for most US regions outside of California, as the trend has now moved nationwide. Unfortunately, not too many people think about the many risks they carry. But experts, such as the doctors at Mayo Clinic, report that they pose a real danger for those who choose to change their bodies in this manner. Health problems range from sore or itchy skin to life-threatening illness. Tattooing and piercing can also cause a great deal of pain, and carry a high risk of infection and allergic reaction.

So why do people get piercings or tattoos? Some teens say they express their individuality. Some are compelled by the fact that their parents hate the fad.

But as Rick found out, trying to be cool with tattoos or body piercings can be dangerous to your health. How do you avoid the risks? First, it’s important to understand just what’s involved in each procedure.

Technique for Tattooing

Tattoos have been used as skin decorations since ancient times. The word comes the Tahitian word tatau, meaning “to mark.”

The tattoo itself is a design created by a tattooist, who draws or stencils the desired pattern on the skin. Then the operator guides a small tattooing machine over the skin in a manner similar to the way a sewing machine works. The machine has one or more needles connected to tubes containing dyes. Each needle repeatedly punctures the skin and releases tiny ink droplets underneath. The procedure may involve significant pain and bleeding. Depending on the size of the tattoo, it may take from a half hour to several hours to complete. If all goes well, the skin heals in one to two weeks.

Tattoo shops are illegal in some states. Even in places where they are legal and are regulated by local licensing laws, they may be prohibited from serving minors.

A Piercing Primer

Body piercings, like tattoos, have been around for centuries. In the United States, piercings other than those on the earlobe were rarely seen before the end of the twentieth century. The American Academy of Dermatology advises against all forms of body piercing except that of the earlobes.

Most piercings are done by a professional piercer, using a pliers-like device that presses a piece of jewelry through the skin or other areas. They can be quite painful–one young man described the sensation as being similar to getting shot with a bullet. Some piercers use a piercing gun, but physicians caution that these cannot be properly sterilized and should be avoided.

What Are the Risks?

Besides the pain and bleeding associated with getting a tattoo or piercing, there are other serious risks and adverse effects. Even in places where hygiene regulations exist, they are often not enforced. This means that many people who administer tattoos and piercings do not follow simple health rules that are designed to prevent infections.

Robin Ashinoff, M.D., chief of dermatologic and laser surgery at New York University Medical Center and chief of cosmetic dermatology at Hackensack University Medical Center, considers infections to be the greatest danger from tattooing and piercing. These infections are caused by bacteria or viruses that get into the body through contaminated needles or other instruments. They can “lead to poor healing of the areas and scarring, in addition to systemic infections like hepatitis,” says Dr. Ashinoff.

A recent study indicates that people with tattoos are nine times more likely to be infected with the deadly hepatitis C virus than are those without tattoos. Unsafe tattooing and piercing practices have also been linked to hepatitis B, HIV, tetanus, and tuberculosis.

The American Red Cross is especially concerned about systemic infections relating to tattooing and piercing. They have issued guidelines preventing blood donors from giving blood for one year after getting a tattoo or piercing.

Localized infections at the tattoo or piercing site are also a serious problem. Tongue piercings in particular are likely to get infected because of the many germs that live in the mouth. If the cartilage around an upper ear piercing becomes infected, this also leads to frequent problems. Dermatologists explain that permanent deformity often results because the cartilage has no blood supply of its own, so antibiotics given to treat the infection cannot get to the infected area. A doctor must then cut out the infection with a scalpel.

No area is 100 percent safe for piercing or tattoos. One teen with a pierced eyebrow developed such a severe infection that the whole area had to be surgically removed.

Allergies and Other Risks

Some people have allergic reactions to the dyes used in tattoos. These may take several weeks to develop. Redness and itching may be severe enough to require a doctor to remove the tattoo. The Food and Drug Administration (FDA) points out that many pigments used in tattoos are not approved for injection under the skin. Ask in advance which dyes will be used and check with a physician about possible allergies.

Allergies to some metals used in piercing are also fairly common, Usually, jewelry made of nickel or other low quality metals is responsible. It’s best to insist on surgical steel or other metals that do not cause allergies.

Another common allergy is to the latex in gloves worn by those who administer tattoos or piercings. These allergies can range from localized itching to anaphylactic shock, a life-threatening condition where the breathing tubes swell shut.

Chipped teeth and receding gums can result from tongue and cheek piercings. The risk increases the longer the person wears the jewelry. Damage results from the metal scraping against the gums and teeth when the individual eats or talks. Tongue piercings in particular result in a need for dental treatments that would not have been necessary otherwise. Because of this, the American Dental Association opposes any sort of oral piercing.

Avoiding the Risks

With all the risks, it’s smart to think carefully before having these procedures. Doctors recommend the following:

* Check with organizations that license or certify tattooists or piercers for proof of accreditation: The Alliance for Professional Tattooists, E-mail info@safe-tattoos.com or The Association of Professional Piercers, E-mail [email protected] safepiercing.org.

* Operators should use an autoclave to sterilize all non-disposable equipment. Once sterilized, instruments should be stored in a sterile bag. All needles should be disposed of after one use. A reputable operator will be glad to answer questions about hygiene practices.

* Operators should use disposable surgical gloves that are thrown away after touching you or anyone else.

* The facility should look very clean, including floors and other surfaces.

* Piercers should use only sterilized hypoallergenic metals. The best ones are gold, surgical steel, niobium, titanium, or platinum.

* Follow up a procedure with proper care. Keep the area clean with soap and water and use an antiseptic cream or rubbing alcohol. For tongue or lip piercings, use an alcohol-free antibacterial mouth rinse. If any pain or swelling develops, consult a doctor.

Dr. Ashinoff offers this advice to teens considering a tattoo or piercing: “I see many people in their 20s and 30s who wish that they had never pierced their eyebrow or tongue or gotten those tattoos because they want a certain job and these may be a social hindrance.” Remember that these body adornments are intended to be permanent. If you’re not sure you want them forever, maybe they’re not right for you in the first place.