Skin piercing treatments

Introduction

Skin piercing treatments include acupuncture, ear-piercing, electrolysis, tattooing, cosmetic piercing and semi-permanent skin colouring.

Tattooing and body piercing are increasingly popular, particularly amongst young people. Although relatively simple, if not undertaken hygienically, skin piercing treatments carry a risk of bacterial infection and, to a lesser extent, blood borne infections such as hepatitis or HIV. They also carry the additional risks of allergic reactions and scarring.

A more recent concern is the reduced cost of equipment and the easy availability of ‘home’ tattoo equipment which increases the number of people being exposed to the risks associated with poor piercing treatments. Risks include not only bacterial and viral infections, but also reactions to inks, scarring and cartilage damage.

Key inequalities and risk factors

In the 2012 research paper Who gets tattoos? Heywood, et al. addressed the lack of evidence on prevalence and characteristics of adults who have ever been tattooed. However, the research found correlations between tattoos and certain behaviours in adults as follows:

  • Gender - Men were more likely than women to report a tattoo, but the highest rates of tattooing were found among women in their 20s (29.4%).
  • Age - Men and women ages 20-39 were most likely to have been tattooed,
  • Educational attainment - men with lower levels of education, tradesmen, and women with live-out partners were more likely to have tattoos.

Tattooing was also associated with risk-taking behaviours, including smoking, greater numbers of lifetime sexual partners, cannabis use (women only) and ever having depression (men only).

A YouGov article in 2015 reported on a survey of 1669 adults which confirmed more women (40%) than men (24%) had tattoos.  The median age of adults for their first tattoo was 21 years of age, although the largest number got a tattoo for the first time between the ages of 16-19. There was a social gradient to tattoos with a higher percentage of adults in the C2DE social classification (40%) than in the ABC1 classification (25%).

While 44% of British adults say they would think no differently about someone if they noticed they had a large tattoo, people are much more likely to think less positively (36%) of the person than more positively (3%) which could limit life opportunities, life chances and social mobility.  A Canadian study shows that women are more likely than men to be judged negatively.

Facts, figures and trends

Skin piercing and the law

The law states that an individual must be at least 18 years to have a tattoo and it is illegal for anyone to have a tattoo under 18 even with parental consent.

Under the Local Government (Miscellaneous Provisions) Act 1982, local authorities in England and Wales can adopt local Byelaws which place legal requirements on tattooists and other skin piercers. The exact requirements vary slightly between local authorities, but all require operators to register with them. Within Bracknell Forest, the relevant Bylaws were updated and reissued in 2013, and now cover the following 6 types of skin piercing:

  • Acupuncture
  • Ear-piercing
  • Electrolysis
  • Tattooing
  • Cosmetic piercing
  • Semi-permanent skin colouring

All applications are reviewed by Environmental Health Officers and the number of new registrations in Bracknell Forest were:

 

2012/13

2013/14

2014/15

2015/16

Acupuncture

2 premises

7 personal

0 premises

3 personal

5 premises

4 personal

0 premises

11 personal

Ear-piercing

1 premises

2 personal

3 premises

7 personal

2 premises

3 personal

3 premises

5 personal

Electrolysis

0 premises

0 personal

3 premises

6 personal

0 premises

0 personal

0 premises

0 personal

Tattooing

1 premises

4 personal

1 premises

1 personal

1 premises

0 personal

2 premises

5 personal

Cosmetic piercing

0 premises

0 personal

1 premises

0 personal

1 premises

0 personal

1 premises

1 personal

Semi-permanent skin colouring

0 premises

1 personal

0 premises

0 personal

5 premises

5 personal

2 premises

2 personal

Total number of new registrations

4 premises

15 personal

6 premises

13 personal

12 premises

13 personal

5 premises

21 personal

Numbers may not total as one person / premise may register for more than 1 treatment.

All premises and persons undertaking skin piercing treatments (including piercing, tattooing, acupuncture and electrolysis) must be registered. The registration includes various conditions to ensure the practices are undertaken with minimum risk and where appropriate visits are undertaken by officers to ensure adequate systems are in place. The Bylaws, in addition to national guidance on the specific risks and changing scope of the industry forms the basis of such visits.

If undertaken correctly the risks associated with skin piercing are small, however, the increasing popularity of ever more varied treatments, combined with mobile piercers and easily available ‘home’ kits means that the risks are increasing. Mobile piercers visit people in their own home and these services may fall outside of the registration requirements for premises, although they would still need a personal registration. Thus whilst officers respond to complaints and queries, there are some circumstances where piercers fall outside of the legal requirements. The number of complaints and enquiries received per year are as follows:

 

2012/13

2013/14

2014/15

2015/16

Number of complaints and enquiries

76

35

40

33

The high number in 2012/13 was due to the changeover to the new Bylaws and so more queries/advice.

Health risks

All of the above procedures involve some degree of skin piercing and therefore carry potential health risks to those undergoing them. These can include

  • Skin infections
  • Allergic or toxic reactions to the substances used
  • The transmission of blood borne viruses such as hepatitis or HIV

The NHS Choices website states that bacterial infection is the main risk associated with body piercings and due to registered piercing premises using disposable sterile needles and other equipment, the risk of passing on viruses such as hepatitis or HIV is now almost non-existent.

According to the NHS Choices website, more than a quarter of people experience complications after having a part of their body pierced, including swelling, infection and bleeding. The health risks of tattooing are highlighted a video from NHS Choices.

Preventative measures

Regulation and enforcement

A visit is undertaken by council officers when an application for a premises registration is first made. Personal registrations may have a visit where appropriate.

However, increasing numbers of mobile piercers largely fall outside of the premises registration  requirements and there has been one example within the borough of school aged children obtaining home kits and tattooing their friends after advertising on Facebook.

It is only possible to monitor non-business and non-registered activities reactively when complaints are received.  There would be advantage in raising awareness with general practitioners, educational and youth clubs to help identify skin piercing operations, particularly those causing damage or infection in order to encourage registration and ensure they are following relevant guidance and legal requirements.

Sector led improvement

Following concerns raised by tattoo and body piercing practitioners, as well as health protection and environmental health specialists, about the lack of robust and consistent guidance on standards of hygiene and safety in the industry, the Chartered Institute of Environmental Health convened a multi-agency steering group working group to develop guidance which was issued in July 2013.  The guidance is supported by a comprehensive toolkit to protect workers and the public, as well as complying with the law.

Reducing occupational health risks

Whilst transmission of blood-borne viruses (BBV) to both patients and workers has been documented in association with clinical procedures, the health and safety executive highlights occupational transmission is also relevant to any procedure in which there is a risk of blood transfer, including acupuncture, body-piercing, tattooing.  Their website sets out a series of steps to avoid exposure, and promote decontamination and disposal of equipment.

Costs

Hospital episode statistics do not collect data specifically on skin piercing treatments with the exception of ear piercing.

According to research by the British Medical Journal in 2008, the number of hospital admissions due to piercings (other than earlobes) was 7. 

In 2013-14 there were 2 hospital admissions nationally and a further 2 in 2014-15 with a diagnosis related specifically to ear piercing – out of approximately 15.5m admissions in 2013-14 and 15.9m in 2015-15.

Want to know more?

More information and resources on controlling the spread of communicable disease is available from the JSNA chapter on communicable disease.

Body piercing in England: a survey of piercing at sites other than earlobe (British Medical Journal, 2008) – estimates of  the prevalence of body piercing, other than of earlobes, in the general adult population in England, and to describe the distribution of body piercing by age group, sex, social class, anatomical site, and who performed the piercings. It additionally provides estimates of the proportion of piercings that resulted in complications and the proportion of piercings that resulted in professional help being sought after the piercing.

Chartered Institute of Environmental Health – information, guidance and best practices on skin piercing practice, training and regulation.

Environment and Sustainability Health Technical Memorandum 07-01: Safe management of healthcare waste (Department of Health, 2013) - practical advice for all those involved in the management of healthcare waste, and is applicable to all who come into contact with or manage healthcare waste.

Healthcare waste (Defra, 2016) – guidance about the legal requirements regarding the disposal of clinical waste.

Tattooing and Body Piercing Guidance: Toolkit (Chartered Institute of Environmental Health, 2013) – the comprehensive toolkit for health care professionals, inspection bodies, practitioners and the general public co-produced by the skin piercing industry. Covers legal framework, good practice, training, work place health, infection control, risk assessment, reporting, after care, jewellery and governance.

Why Would You Get THAT Done?! Stigma Experiences of Post-Secondary Women with Piercings and Tattoos (Martin, Cayla, 2013) - Research into  piercings and tattoos and the existence of commonly held stereotypes and assumptions (stigmas) and the impact the hireability of those with body modifications.

 

This page was created on 27 February 2014 and updated on 22 June 2016.  

Cite this page

Bracknell Forest Council. (2016). JSNA – Skin Piercing Treatment. Available at: jsna.bracknell-forest.gov.uk/people-places/wider-determinants-health/environment/skin-piercing-treatment (Accessed: dd Mmmm yyyy)

 

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