The price of pier ing

When it comes to body piercing, the formerly fringe procedure that has moved into the mainstream, medical experts have a message: Don't try this at home. Or maybe at all.

Those warnings by groups representing dermatologic surgeons, dentists and other medical authorities have acquired new urgency after two cases in which teen-age girls nearly died as a result of infections they developed from botched piercings.

Three weeks ago Indiana surgeons removed the breast of an 18-year-old diabetic whose torso was invaded by flesh-eating bacteria surrounding the nipple rings she acquired at a salon to celebrate her birthday. A few days later a Boston mother was sentenced to 18 months in prison for failing to seek medical attention for her 13-year-old daughter, who suffered major organ damage from an infection that resulted after the girl pierced her own belly button.

Other reports in medical journals include a sewing needle that disappeared during a do-it-yourself tongue piercing and had to be extracted by oral surgeons; a variety of serious, drug-resistant bacterial infections; hepatitis and tetanus; fractured teeth and nerve damage from tongue studs; as well as permanent scarring.

"People think it's hip and cool, but they don't realize that it's not like getting your ears pierced," said Eugene Giannini, president of the D.C. Dental Society, who, like the American Dental Association, opposes oral piercings. Giannini said he has seen gum damage and speech problems among his nearly two dozen patients who have tongue studs. "I think people need to be informed consumers if they're going to have it done."

For nearly half a century, earlobe piercing - one hole in each ear - has been a rite of passage for American teen-age girls. In the past decade, the practice of using a needle to make tiny holes in the upper ear, nose, tongue, lip, eyebrow, nipples or even genitals for the purpose of wearing body jewelry has become more common, doctors say, particularly among those under 30.

For some wearers, piercing is a statement of rebellion or of self-expression; for others the adornment is purely decorative. Body piercing is widespread in some cultures.

It's impossible to determine how many Americans have piercings - or how many have problems as a result. A study published two months ago in the Journal of the American Academy of Dermatology involving more than 500 participants between 18 and 50 found that 24 percent had tattoos and 14 percent had piercings other than in an earlobe. Piercings were more common among women.

"It's become remarkably popular," said Jeffrey S. Dover, a dermatologic surgeon in Boston who says he routinely sees patients, most of them young and female, sporting hoops on their upper ears, barbell-shaped tongue studs or jeweled navel rings. "A lot of my nursing staff have them," he added, attributing the popularity in part to the influence of numerous celebrities with piercings, among them Britney Spears, Lindsay Lohan, Tommy Lee and Dennis Rodman.

Twenty years ago, observed Dover, who is affiliated with the Yale University School of Medicine, it was rare to see a man wearing an earring. These days many professional football players sport at least one glittery diamond stud the size of a nickel.

Those under 30 are not the only devotees of piercing, said Doris J. Day, a cosmetic dermatologist who practices on Manhattan's posh Upper East Side. "I do skin cancer checks on my patients every year, and some of the most buttoned-down CEO types - people you'd never expect to have piercings - have them where you least expect it," said Day, who estimates that at least 50 of her patients wear jewelry in places other than the earlobe.

Donna I. Meltzer, an associate professor of family medicine at the State University of New York at Stony Brook, said she became interested in the subject about seven years ago after treating a spate of pregnant women with infections from navel rings - and could find virtually nothing in the medical literature.

"I sort of became an expert by default," said Meltzer, author of a widely cited article about the complications of body piercing published last year in the journal American Family Physician.

Meltzer, who said she is "neither for it nor against it," said she believes many patients don't appreciate the risks of piercing - or realize that it leaves a permanent hole in the skin that doesn't close even after jewelry is removed. Most piercings are performed with a needle and without anesthetic, although sometimes a topical numbing agent such as lidocaine is used.

Doctors say that while pierced earlobes sometimes become infected, other sites are more often prone to complications because they tend to be subjected to friction or continuous moisture, which can contribute to the growth of bacteria. In other areas, such as the cartilage in the upper ear, the lack of blood vessels can retard healing. And the mouth is teeming with bacteria.

Meltzer said she is particularly concerned about the lack of sterility in some tattoo parlors, where many piercings are performed; the proliferation of teen-age "piercing parties" where booze is used as an anesthetic; and, in most states, the lack of regulation of an invasive procedure capable of transmitting HIV and other blood-borne diseases. (The District of Columbia has no regulations governing piercing, officials say. Virginia prohibits piercing of minors without parental consent, while neither Virginia nor Maryland requires routine inspection of shops performing piercing.)

John Rowan, a registered nurse who owns Rendezvous Tattoo and Body Piercing, one of at least five such shops in Blacksburg, Va., home of Virginia Tech, said he thinks the dangers are exaggerated.

"I don't think there have to be any medical risks at all if it's done correctly," said Rowan, who charges $50 for a nostril piercing - one of the most popular adornments - and has several piercings himself. "You've got to remember that the medical community only sees the downside. For every one infection they see, there are 1,000 that are trouble-free. Nobody comes into the ER to tell you how great their piercing is."

Rowan, who said he has pierced the navels of girls as young as 12 who were accompanied by their parents, said he thinks more regulatory oversight is needed. Many piercers, noted Rowan, a member of the nonprofit Association of Professional Piercers, learn the craft by apprenticing at a studio. And in Virginia, he notes, body piercers come under the jurisdiction of the board that regulates barbers, not the health department.

Making piercing safer

Piercing a body part carries inherent risks, but medical experts say there are ways to lessen the likelihood of complications. Here are some:

• Never do it yourself - or have a friend pierce a body part for you. This could lead to serious infection as well as permanent disfigurement.

• Do not use alcohol as an anesthetic or decide to get a piercing when you have been drinking or using drugs.

• Check out the cleanliness of a piercing salon before a procedure. Ask the person doing piercings how many he or she has performed. The piercer should wash his or her hands, wear gloves and use a fresh needle taken from a sealed package. The Association of Professional Piercers (888-888-1277, www.safepiercing.org) maintains a list of members who agree to abide by its standards, which tend to be stricter than many laws governing piercing.

• Do not allow a piercing gun to be used, except for standard earlobe piercing. It is not sterile and can damage tissue.

• Use only hypoallergenic jewelry, such as surgical grade steel, gold, platinum or titanium. Nickel or brass can cause an allergic reaction; sterling silver can leave a permanent gray stain on skin.

• Follow after-care instructions carefully and keep the area clean and free of irritation during the healing period.

• Seek medical attention at the first sign of a problem, such as redness, pain, swelling, fever, discharge or a foul smell. Do not treat it yourself or assume it will go away in a few days.

- SOURCES: American Society for Dermatologic Surgery, Mayo Clinic Foundation, Association of Professional Piercers