Dermatologists Say Body Piercing Can Stick Patients With Medical Problems

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Risks include infections, scarring, and lifetime allergy to nickel

With the popularity of body piercing growing among women and men, dermatologists are today warning consumers of the health risks associated with this fashion statement - risks that can include infection, massive scarring, the spread of communicable diseases and the onset of a life-long allergic reaction to common metals - especially nickel.

Dermatologists and health officials generally favor regulation and, so far, eight states have legislation governing body piercing already on the books or pending. In California, both the state dental and medical associations strongly favor the regulation of body piercing. The dental association is particularly concerned with the permanent loss of sensation that can occur - especially when tongues are pierced.

Dr. Peter Bendetsen, a Boston-area Dermatologist, urges caution. Says Dr. Peter Bendetsen, "Body parts such as navels, tongues, eyebrows and lips are far more prone to infection and, the thicker the body part, the greater the chance of uncontrollable bleeding. I recently had to give a patient a stitch because he hit a vein when tried to pierce his own lip." Many people with nickel allergies believe wearing 14 kt. gold will prevent further outbreaks. However, says Dr. Bendetsen, "I just saw a patient with a rash under his gold watchband. Precious metal alloys are no protection once a person has been sensitized to nickel." Dr. Bendetsen, who has been practicing dermatology in the Boston area for over 20 years, adds, "Piercing is an invasive procedure. Every precaution should be taken to insure that instruments are properly sterilized and sanitary conditions prevail, otherwise, the risk of infection is enormous. There should be regulations to insure that body piercing is done in a sanitary fashion. Just boiling instruments isn't enough - they should be sterilized in an autoclave."

Dr. Pamela Scheinman of the New England Medical Center says "We are seeing an increase in patients with allergies to nickel content and sometimes to cobalt that may also be present," says Dr. Pamela Scheinman a dermatologist and allergy specialist with the New England Medical Center. She explains, "Cells in the body react to the presence of nickel in the studs used to keep the pierced site open. The cells develop a mechanism to react against the metal causing the skin to erupt. Unfortunately these cells - known as T-Cells - develop a memory. Every time nickel comes into contact with skin, the T- cells think they are doing your body a favor by reacting. Eyelids, a popular site for piercing are particularly sensitive." In addition to developing a reaction to nickel in earring studs, patients can become allergic in other ways. Eating foods high in nickel such as shellfish, chocolate milk, and beans can set off a reaction. "The allergy can even develop from something as simple as chewing on pens and paper clips while at work," notes Dr. Scheinman. Some people become so sensitive to nickel that their skin reacts to zippers, bra clasps, and eyeglass frames around the back of their ears and nose. Reactions can even stem from nickel in pots and pans and metal egg beaters, mixing spoons and bowls.

Those suspecting nickel allergies may obtain a jewelry testing kit from Allerderm in Mill Valley, California. The kit includes DiMethyl Glyoxine and Ammonium Hydroxide which are mixed together and daubed on the jewelry with a cotton swab. If the metal turns pink, nickel is present.

Fisher's Contact Dermatitis, edited by Fowler and Riechtel, a standard guide for dermatologists cites Roman Research in Hanson, Massachusetts as a reliable source for jewelry that is nickel safe. The company invented the first one-step ear piercing system that uses a surgical stainless steel stud to puncture the lobe. The sterilized stud is used only once and remains in the lobe until the puncture heals, thus there is no danger of transferring pathogens from one individual to another. Surgical stainless steel is recommended by the medical community because it will not provoke a nickel allergy.

The British Journal of Dermatology, in a 1996 study reported, "Between 9% and 48% of all people may become sensitized to nickel at some point in their lives, making nickel the most common source of contact allergies in the industrialized world.... Even in small doses, nickel can cause painful topical rashes and skin irritations." Nickel reactions can be severe enough to keep someone home from work for a week or more. The reason, according to this British medical journal, "Nickel is often used as an interliner in gold-and-silver plated objects, but comes into contact with the skin as sweat erodes the precious metal."

Dr. Donald Belsito, professor of Dermatology at the University of Kansas in Lawrence and a member of the North American Contact Dermatitis Group, notes, "Nickel allergies are on the increase - from 10.5 % cited in studies done from 1985 to 1989 to 14.3 % in studies done in 1996. More men are showing up with nickel allergies; coincidentally more men are having their bodies pierced. This indicates a possible correlation between piercing and allergies to nickel." In addition to setting off allergic reactions, Dr. Belsito, notes, "Piercing cartilage around the top of the ear poses greater risks than piercing the lobe. Cartilage is an inert material with very little blood supply and takes a long time to heal from the puncture. Also, when cartilage becomes infected, it is difficult to treat because of its low blood supply.

"Also, the growth of overwhelming scars known as keloids can occur and the condition is particularly prevalent among African Americans," says Dr. Belsito, adding, "Keloids can grow to be as big as the ear itself. The cure requires administering medication that reduces the tendency to develop scars. If scars do develop, they need to be removed by a plastic surgeon. The risk, of course, is that people who tend to scar, may not fare well in surgery which can promote new scar tissue." When it comes to protecting the consumer, Dr. Belsito adds, "I think hypoallergenic is a bad term since it only tells you that the product is manufactured without an ingredient to which most people are allergic. But it doesn't tell you other possible allergy provoking ingredients. For example, some rubber gloves labeled hypoallergenic are made without certain chemicals. However, these gloves could be made of latex which is lethal to some people."

Drs. Bendetsen, Scheinman and Belsito favor legislation governing body piercing due to the risk of nickel allergies, loss of sensation and communicable diseases resulting from poor sterilization procedures. To date, Arizona, California, Georgia, Michigan and Washington have passed legislation requiring parental consent for body piercing if you are a minor. Several states including Delaware, Missouri, Texas and Hawaii have legislation pending.

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