Piercing

Piercing (English to pierce: “pierce”, “pierce”) is a piercing of the skin with subsequent attachment of a piece of jewelry made of metal (titanium or steel). Piercing is a type of body modification and has been a part of various people’s practices on almost every continent in numerous cultures for thousands of years. In today’s Western society, piercing appears as a fashionable phenomenon, especially among young people. Piercing is controversial to discuss, as the medical consequences are sometimes significant and should be weighed against the cosmetic benefits.

Indications (areas of application)

Piercing represents a body modification without a medical indication.

Contraindications

• Allergy to piercing jewelry
• Alcohol and drug influence
• Acute infection with fever
• Increased bleeding tendency – e.g., taking anticoagulants (anticoagulant medications) or hereditary bleeding tendency.
• Skin diseases – e.g. psoriasis (psoriasis).
• Heart valve defects – risk of endocarditis (endocarditis).
• Local infections
• Wound healing disorders – e.g. in diabetes mellitus.

Before the procedure

Before the procedure should be a detailed explanatory interview. Since piercing is an invasive measure or legally bodily injury, the written consent of the person concerned must be obtained. If the person is a minor, the written consent of the parents must be obtained.

The procedure

During the procedure, the patient should be in a comfortable position. If necessary, disturbing body hair should be removed. Furthermore, before performing the piercing, care should be taken to thoroughly disinfect hands and the area of the body to be treated. The treating person should wear sterile gloves and use sterile materials. The puncture site is marked and the tissue is fixed with a clamp. The puncture is then performed at the angle dictated by the anatomy using a sterile indwelling venous cannula (peripheral venous catheter). The needle is removed and the jewelry is inserted through the remaining plastic portion of the cannula. This is followed by careful wound disinfection and dressing with a sterile dressing and band-aid.

After the procedure

Regular wound checks should be performed to detect the occurrence of infections or other secondary diseases. If secondary diseases occur as a result of piercing, there is an obligation to notify the attending physician, since it is the result of a medically unnecessary treatment. Therefore, legally insured patients must participate in the costs of an incurred complication to a reasonable extent. In addition, there is no entitlement to continued payment of remuneration in the event of incapacity for work.

Possible complications

Common complications include:

• Allergy – e.g. contact dermatitis.
• Bleeding
• Frostbite of the surrounding skin at very low temperatures.
• Ingrown jewelry parts
• Endocarditis (inflammation of the inner lining of the heart)
• Tear out a piercing with injury and scarring.
• Keloids (excess scar growth)
• Redness
• Swelling
• Infection – Local infections such as erysipelas (erysipelas) or phlegmon (purulent, diffusely spreading infectious disease of soft tissues), usually caused by Staphylococcus aureus or Streptococcus (bacteria).
• Migration or displacement of the piercing.
• Nerve injury
• Post-streptococcal glomerulonephritis (kidney inflammation resulting from an exaggerated immune response to streptococcal infection).
• Sepsis (blood poisoning) – Systemic, severe infection that can lead to death.
• Tetanus (tetanus) – in the absence of vaccination.
• Non-menstrual toxic shock syndrome – Severe sepsis (blood poisoning) with systemic inflammation caused by endotoxins (toxins) from Staphylococcus aureus. This clinical picture can also result from the improper use of tampons.

Furthermore, there is the possibility of specific complications in the area of the respective body regions that are pierced. Facial piercing:

• Angina Ludovici – phlegmon of the floor of the mouth (severe inflammation of the floor of the mouth) in tongue piercing.
• Chondritis (cartilage inflammation) as well as periauricular abscesses when percing the auricles.
• Granulomatous perichondritis of the nostrils.
• Nasal septal hematoma (hematoma of the nasal septum).
• Damage to the teeth and periodontium (eg, lip piercing).
• Injury to parts of the trigeminal nerve (facial nerve) in facial piercings (eg eyebrows).
• Tongue abscess in tongue piercing
• Tongue swelling with constriction of the upper airway in tongue piercing
• Cerebral abscesses (brain abscess).

Nipple piercing, navel piercing:

• Granulomatous mastitis (inflammation of the breast).
• Galactorrhea – Pathological (abnormal) secretion of milk outside of gravidity (pregnancy) and lactation.
• Infection of breast implants
• Omphalitis (inflammation of the navel)
• The estimated cumulative complication rate of intimate and nipple piercings is up to 10-15%.

Genital piercing (genital piercing; intimate piercing):

• Infections, bleeding, allergic reactions and nerve injury.
• Condylomata acuminata (genital warts).
• Scarring (eg, urethral strictures / constriction of the urethra).
• Fournier’s gangrene – necrotizing fasciitis of the groin and genital area (foudroyant life-threatening infection of the skin, subcutis (subcutaneous tissue) and fascia with progressive gangrene; often patients with diabetes mellitus or other diseases leading to circulatory disorders or reduced immune defenses; surgical treatment urgently needed).
• Increased risk of infection with sexually transmitted diseases (hepatitis B, hepatitis C or HIV) if the piercing has not healed.
• Infertility (infertility).
• Paraphimosis (synonym: Spanish collar) – constricted foreskin (phimosis), which pinches the glans of the penis (medical emergency!).
• Prostatitis (inflammation of the prostate)
• Priapism (permanent erection)
• Sexual insensations
• Strictures and adhesions
• Tearing out the piercing
• The estimated cumulative complication rate of intimate and nipple piercings is up to 10-15%.