Health risks of piercings

“One in four body piercings goes wrong”, reports The Independent today. The newspaper goes on to say that body piercings, which have become “an essential fashion accessory”, carry significant risks, according to the first study to examine complications arising from this body art. “One in 10 adults in England has had a piercing somewhere other than the ear lobe,” the newspaper says.

The story is based on a survey of 10,000 people aged over 16 in England, and provides information on the number of people with piercings in the UK. Due to its sampling method, there are shortcomings which should be kept in mind when looking at the results. The bottom line, however, is a sensible one: people wanting a piercing should go to an experienced specialist and follow recommendations to keep the site clean so as to avoid infection.

Where did the story come from?

Dr Angie Bone and colleagues from the Health Protection Agency and the London School of Hygiene and Tropical Medicine in London carried out this survey. It was published in the peer-reviewed medical journal British Medical Journal .

What kind of scientific study was this?

The research behind these reports is a cross-sectional study (a survey) of adults aged over 16 years old, carried out in England between January and March 2005. There was a two-stage selection process for the survey. The first was a random sample of geographical areas (comprising about 300 households each), and the second stage was selective sampling (of individuals within those households). The researchers ensured that they had a representative sample across regions, demographics and lifestyle variables. In total, 694 neighbourhoods were sampled. Within these areas, interviewers were given lists of potential households and suggested quotas/numbers of people they needed to interview, as well as their characteristics. Interviewers were instructed to interview one person per household and, if they did so, not to interview the person next door or next door but one.

Individuals were asked whether they had or had ever had any body piercings (excluding in their earlobes). Those that said yes gave more details about their individual piercings, namely where it was, and whether they had experienced any health problems with it. They were also asked which sources of professional help they had sought to deal with the complication. Respondents were able to respond directly onto a laptop, so that they did not have to give their answers verbally. In total, the researchers received responses about piercings from 10,503 adults. The researchers used the 16 to 24 year-old age group to analyse the rate of complications overall, the proportion serious enough to seek medical help, and to determine which piercings led to the most complications.

What were the results of the study?

1,049 (10%) people aged over 16 reported having or ever having a piercing. Piercing was more common in women and in the younger age group (16 to 24 years), and was less common in London than in other regions. The majority of piercings were in the navel (33%), followed by nose (19%), ear (13%), tongue (9%) and nipple (9%). Other body parts made up the remaining proportion. Overall, the majority of piercings were done in specialist piercing/tattoo parlours.

Complications were reported in 28% of cases, and in 13% of these cases the complication was serious enough to seek help. Although the researchers say that in the 16 to 24 age group they found “slightly higher proportions of piercings in which complications developed and respondents sought further help”, they did not statistically compare the prevalence of infection across different ages.

Of the 1,531 young people (16 to 24 years old) surveyed, 754 had a piercing. Looking at this age group in detail, tongue piercing (50%) was most likely associated with complications, followed by genitals (45%) and nipples (38%). Help was most often sought for genital piercings (45%). There were seven serious complications (requiring hospitalisation) in this age group (less than 1%), and these were more likely with non-specialist piercings (4/134 versus 3/620).

What interpretations did the researchers draw from these results?

The researchers conclude that their survey has found that overall body piercing is more common in women than men and in younger age groups. Among the 16 to 24 year-olds, complications, including those that were serious enough to warrant hospitalisation, were more common if the piercing had been done by a non-specialist.

What does the NHS Knowledge Service make of this study?

• The study was not designed to detect whether piercings are associated with transmission of blood-borne viruses (hepatitis C, HIV) or with fatal complications. Some newspapers imply that this study suggests that risk of hepatitis infection is increased. These suggestions may have been made by other professionals, but this was not assessed in this survey.

• The absolute numbers who sought help from the NHS (GP, A&E, hospital, NHS Direct) was quite small. Many people went back to their piercer for advice if they felt their complication was serious enough. It is unclear what exactly the “burden on the NHS”, as some newspapers report, is based on, as it was a small absolute number of complications that led to help-seeking behaviour. 

• As the researchers themselves say, their sample may have been biased because they did not randomly select individuals from the population. There was no record of those who refused to participate or who could not be contacted. If the piercing and complication rates in these people were significantly different from those recorded, this would have swayed the overall results in one direction or the other. They also say that although a written or verbal questionnaire was not used (a laptop instead), there may have been some response bias if people chose to report only some of their piercings. Responses about complications may not have been entirely accurate and were not verified.

The majority of piercings in the age groups were not associated with any reported complications. Complications themselves were usually not serious and were self-limiting. It is sensible to advise people who want to have a piercing to do it through an experienced specialist and to follow recommendations to keep the site clean so as to avoid infection.

Sir Muir Gray adds...

A peculiar habit, which obviously increases health risks but these data will have little effect on the potential piercees.