Clinical Guidance on Body Modification Among Youth

Summary and Comment |
September 15, 2017

Clinical Guidance on Body Modification Among Youth

  1. Alain Joffe, MD, MPH, FAAP

An AAP report provides in-depth information to guide clinicians and young people about tattooing, piercing, and scarification.

  1. Alain Joffe, MD, MPH, FAAP

Although body modification (tattooing, piercing, and scarification) has become mainstream, it can still pose a risk to a young person's health. The American Academy of Pediatrics (AAP) has issued its first clinical report on the subject. Key points are as follows:

Background Information

  • Current data no longer support the concept that body modification occurs primarily among high-risk youth. Furthermore, body modification should not be confused with nonsuicidal self-injury.

  • Body-piercing jewelry generally consists of hoops, rings, studs, or barbell shapes; most are made of stainless steel, gold, niobium, titanium, or alloys. Most piercing guns are not sterilized.

  • Scarification creates words or images in the skin through cutting, burning, or branding. Scarification may not produce the desired result, at least in part because it is less in demand, so artists may be less experienced in the technique.

Anticipatory Guidance for Patients

  • Adolescents and young adults should be advised to carefully assess the hygiene practices of the establishment and artist (e.g., use of disposable gloves; use of sterile needles/equipment removed from a freshly opened package; use of fresh, unused ink poured into a sterile container)

  • Adolescents and young adults should understand that visible body modifications may negatively affect employment prospects.

Clinical Management

  • Complications from tattooing are relatively uncommon but may include inflammation, both bacterial and viral infections, neoplasms, and, rarely, vasculitis. Infection typically occurs 4 to 22 days after the tattoo is placed.

  • “Q-switched” laser is now the preferred method for tattoo removal.

  • Youth with newly placed oral piercings should rinse with nonprescription oral cleansers or apply them topically to the piercing. Tongue piercings have a high rate of tooth chipping.

  • Healing times for piercings vary from 2 to 6 weeks for the clitoris, urethral meatus, or tongue and up to 2 to 4 months for nipples and 9 months for the navel or glans penis.

  • Although reliable frequency estimates are unavailable, reported complications from piercing include infection, pain, bleeding, hematomas, cysts, allergic reactions, and hypertrophic scarring/keloids. Up to 35% of ear piercings develop complications. Young people who are immunocompromised (e.g., those with diabetes or taking immunosuppressive medications) are at increased risk for complications.

  • As with tattooing and piercing, keloid formation is a possible complication of scarification.


Issues of employment aside, body modification poses little risk if performed by experienced artists using careful sterile and hygienic techniques. This report contains detailed information about each method, including handy tables summarizing complications and healing times. Among the resources included, my favorites are:,, and

Editor Disclosures at Time of Publication

  • Disclosures for Alain Joffe, MD, MPH, FAAP at time of publication Editorial boards JAMA Pediatrics


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