Editor's Note: This is part 1 of a two-part series focusing on body art. Check out part 2 on tattoos.
The canvas comes in many shades, shapes and sizes, and the artwork that adorns it can be as simple as a silver stud. Body art is a booming business, attracting many people, including those with bleeding disorders. A 2006 study published in the Journal of the American Academy of Dermatology showed that 34% of Americans 18–50 years old have an ear lobe piercing.
“I think this generation sees it more as your body is your canvas—you show off your life and your own individuality through it,” says Michelle Finnerty, 24, of Fowlerville, Michigan. She is a junior psychology major at Eastern Michigan University in Ypsilanti. Finnerty has von Willebrand disease, type III, and sports several piercings and two tattoos. “The more I see it on other people, the more I like it.”
Indeed, with the proper precautions and preparation, body art can be done safely on people with bleeding disorders. But it’s important to understand the risks involved before you make an impulsive decision that could have lifelong consequences.
Musicians, athletes and celebrities have helped make piercings fashionable for men and women, and not just in the ear. The nose, navel, eyebrow, tongue and lip are common sites for piercings.
Finnerty got her first piercing, in her ear, when she was 19. “I had considered the risks,” she says. “It was quite intimidating.” She waited a year to get up the gumption to do it.
In the meantime, Finnerty talked to friends from Camp Bold Eagle in Holton, Michigan, where she is the arts and crafts director. “They said, ‘As long as you infuse before and take preventive care, you’ll be fine.’” She also consulted the camp nurse. “I know I can’t hold you back,” he told her. “So if you’re going to do it, you have to treat.” Finnerty’s parents presented even more resistance. With her history of severe joint and muscle bleeds, they were worried. “They absolutely did not want me to do it,” she says. But Finnerty was careful. “For piercings, I always infused.”
That’s something hemophilia treatment centers (HTC) endorse. “Infuse an hour before the procedure, so your factor level is high enough to prevent bleeding,” says Jennifer Maahs, MSN, PNP, Indiana Hemophilia & Thrombosis Center, Indianapolis. She was a speaker for a session on body art at the National Hemophilia Foundation’s 64th Annual Meeting in Orlando in November 2012.
The shop Finnerty went to for her piercing was licensed by the local board of health, and her piercer, a long-time family friend, took her medical history—steps recommended by the Association of Professional Piercers, an international organization that sets health and safety standards. (See “Insuring Your Artwork” sidebar below.) “He asked me about previous bleeds I had had and touched on what he thought might happen,” she says.
During the procedure, Finnerty’s piercer explained each step. “He said, ‘You never want to have anything done by somebody who doesn’t open everything fresh in front of you.’”
Afterward, Finnerty followed the printed instructions on caring for her piercing. “Every 2 to 4 hours I would wash it with the antibacterial soap, then a saline soak, and then put the jewelry back in,” she says of the first week. She followed the regimen daily for another month. “I went above and beyond what they suggested.”
Ear piercings went well for Finnerty, but not so her navel piercing. After a year, it became infected. “I got worried, so I took it out eventually,” she says. “It healed fine.”
Finnerty’s infection was not unusual. A 2012 study co-authored by Jaime Holbrook, MD, a dermatologist at Northwestern Memorial Hospital in Chicago, and published in the American Journal of Clinical Dermatology, found that localized bacterial infections are the most common complication of piercings, affecting 20% of patients. Allergies to the metal in the jewelry can cause swelling, a skin rash and even labored breathing. Bleeding, tearing, keloid formation (the development of lumpy scar tissue during healing), scarring and nerve damage can also result.
More severe symptoms cited by the study include systemic infections, such as sepsis, toxic shock syndrome and viral hepatitis. Although rare, abscesses in the brain have also occurred.
Oral Piercing Problems
Because the mouth is home to hundreds of different types of bacteria, oral piercings can present unique issues. Creating a hole in the lip or tongue provides a route for Staphylococcus and Streptococcus bacteria to enter the bloodstream, possibly causing bacterial endocarditis, an inflammation in the lining of the heart that can destroy heart valves.
Further, the tongue is supplied with blood vessels and nerves. “The people who we’ve seen have problems are the ones who get the tongue piercing,” says Maahs. “It takes weeks to heal.”
A tongue piercing involves inserting a barbell-shaped piece of jewelry vertically in the mouth. The post that rests on the surface of the tongue makes a tantalizing toy. “Constant playing with it can chip the enamel and fracture healthy tooth structure,” says Melissa Kennell, DDS, of Children’s Dentistry of the Lakes Region, Gilford, New Hampshire.
A lip ring can also cause harm. “It rubs against the gingival tissue, right where the tooth meets the gums,” Kennell says. Once the gum recedes, the root of the tooth is exposed. It can only be repaired via periodontal surgery. “That is huge for somebody with a bleeding disorder,” she says.
Kennell laminated photographs of tooth and gum injuries from piercings for her teenage patients. “We show them the damage it causes, so that they understand the repercussions of getting a tongue or lip ring.”
Kennell’s son, Preston, has severe hemophilia A. Although he’s only 5 now, she says she will not allow him to get an oral piercing when he’s older. “I would be concerned about the bleeding, but my biggest concern is you’re ruining your teeth and your gums.”
You also could be ruining your ability to speak and eat, according to the Holbrook study. Oral piercings can cause infection and swelling in the tongue, and excess salivation. The jewelry can become embedded or even swallowed, requiring surgery. For these reasons, the American Dental Association (ADA) opposes oral piercings.
Skin Stretching Takes Time
Gauging is another form of body art that people use to express themselves. The term “gauge” refers to the size of the earring used to stretch the ear lobe. For instance, a 20-gauge earring is about 1/32nd of an inch; a 00-gauge earring is 3/8”. After the initial piercing, a stainless steel tool called a taper is placed in the hole to gradually stretch it to the desired size.
“For someone with a bleeding disorder, gauging is the least risky type of body art,” says Maahs, “I have no concerns regarding it because it’s such a slow process.” That process differs for everyone, but usually takes 1–2 months for each gauge size. As the hole enlarges, earrings called plugs are worn. Aftercare is similar to that with any piercing. An added step is to lubricate the area with jojoba oil.
Complications from lobe stretching include tearing, keloid formation and infections. Using plugs made from a porous material like bone can trap bacteria, so surgical steel or a metal like titanium is a safer choice.
Although piercings are common, those with bleeding disorders should carefully weigh the risks, as well as the potential impact piercings could have on career or family life. “It’s such a touchy subject still,” Finnerty says. She talked to her parents first before going through with it. “You don’t want to cause disappointment.
Holbrook J, et al. Body piercing: complications and prevention of health risks. American Journal of Clinical Dermatology, 2012; 13(1): 1-17.
Get information and find a member of the American Association of Professional Piercers.
American Academy of Dermatology: Tattoos and body piercings.