Vignettes from
Adolescent Practice
Patricia J. Kelly, MD
Adolescent Medicine
Marshall University School of Medicine
June 2012
 OBJECTIVES
◦ Anticipatory guidance
◦ Mainstream vs risky behaviors
◦ Medical complications
◦ “Asking permission”
Got skin…
…will pierce
Fashion?
Risky Behavior?
Earlobe
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very common
accepted mainstream
Body piercings (other than earlobe)

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High schoolers:
10 to 33%
College students:
∼50%
2004 Phone Survey 18 to 50 yo
 1st body piercing: < age 18

Piercing care?
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Contemplation?
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Relevant
◦ Physical activities
◦ Medical conditions

Regrets
◦ 13-18% removed
 Disappointed
 Bored

Parents
Social reactions
www.youngwomenshealth.org
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Diabetes
Congenital Heart
Obesity
Autoimmune
disorders
Systemic Steroids
…
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“Nickel” sensitivities
Dermatitis
◦ Atopic
◦ Sebopsoriasis
Keloids
◦ Patient history
◦ Family hx
Surgical (Implant) grade stainless steel
 Niobium
 Titanium high polish
 Gold 18K
 Solid Platinum
 Teflon/nylon

Saline Solution
 Antibacterial soap
∅ alcohol
∅ hydrogen peroxide
∅ ointment

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Wash X 2 day
Remove crusts
Rinse
Dry: paper towel
Wash Hands
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Avoid friction/trauma
Avoid pools/hot tubs
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Rinse after excercising
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Keep jewelry in place
until healed
Signs of infection see
health care provider
Keep area clean
Piercing: Healing Time!
 Ear Lobe/Eyebrow
 Ear Cartilage
 Navel
 Nostril
 Nasal Septum
 Tongue
 Lip
 Nipple
 Female G
 Male G
6 to 8 wks
4 to 12 months
4 to 12 months
2 to 4 months
6 to 8 months
4 weeks
2 to 3 months
3 to 6 months
4 to 10 wks
1 to 6 months
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Infection Prone
◦
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Moist
Slow Healing 4-12 mo
Staph
Fungal

Clean clothes

Soft fabric

Loose fitting
◦ ∅ belts
◦ ∅ tights
Migration
◦ Pregnancy

Jewelry
◦ “fixed”
◦ Curved barbell

Rinse after excercise

Oral piercings
◦ Rinse

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Antibacterial
Alcohol free
Saline
Dilute peroxide
◦ New soft toothbrush
◦ ∅ Kissing/oral sex
 4-6wks/healed
◦ Check for loose parts
No Smoking
Clean clothes
 Soft fabric
 Snug shirt
 Sports bra
 Rinse p̄̄̄̄ excercise

 Mainstream?
 Or
 Risky
Fashion
Behavior?
Expression
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Fashion Statement
Self Identity
Peer acceptance
Group membership
Sensual pleasure
Self Injury
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50% good students
Similar to peers
◦ Parental education
◦ Family relationships
◦ Religion involvement
More Colorful…
cross section of society!
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Substance Use
Sexual Activity
Binge Drinking
Defiant behavior
Gang membership
Anger
Depression
Suicidal
Risky behaviors….
Cluster…
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Trends
◦ Female > male
◦ Naval: Female
◦ Nipple: Male
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Red Flags?
◦
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Younger age
Tattoos
Cutting
Burns
Ear cartilage: gateway?
Parents
Friends
Self Identity?
Group Membership?
Meltzer. AFP 2005
Pocketing
Gauge
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Web instructions
◦ TOOLS
◦ JEWELRY
◦ SHOPS
You Tube videos

Asking Permission
◦ Would it be ok if I asked?
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Other piercings
Other body art
Get the story
Paint the picture
Exam the skin
Respect
MI: Self efficacy
Piercings
 Earlobe
 Gauge
 Cartilage
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Other sites?
Contemplating
Tattoos?
Self injury?
Rook
Plug
Honor Student
 Asthma
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◦ Intermittent
◦ Moderate
Eyebrow piercing
… migration
Risky …
…
Fashion?
Infection
 Allergic (dermatitis)
 Keloids
 Bleeding (bruising)
 Tears
 Migration (rejection)
 Epidermal cyst
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Infection vs Dermatitis
High rim cartilage
◦ Poor blood supply
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Pseudomonas
◦ Green drainage
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Perichondritis
◦ Acute tenderness
◦ Spares earlobe
 abscess
 necrosis
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Bacteria
◦ Staph
◦ Pseudomonas
◦ B strep
Fungus ?
 Potential
Tetanus
Hepatitis B
Hepatitis C ?
 HIV: no cases
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Complications
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Abscess
Acute
Glomerulonephritis
Endocarditis
Septic Arthritis
Osteomyelitis
Toxic Shock
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Warm Compresses
Antibacterial Soap
Antibiotics
No topical ointments
Leave jewelry in place
◦ Replace with temporary IV catheter
◦ Commercial removal kit

Got her tongue
pierced and it
looks awful…
Meltzer. AFP 2005
Long Bar
Short bar
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Dental
◦
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Duration of piercing
Chipped/Cracked Tooth
Gingival Injury/recession
Root Canal
Other
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Increased salivation
Chewing/swallowing
Speech
Taste/numbness
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Infections
◦ Staph
◦ Strep viridans
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Tongue piercings

Case reports
◦ Infective Endocarditis
◦ Ludwig’s Angina
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Mainstream
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◦ Anticipatory Guidance
◦ Aftercare
◦ Risk taking behaviors
◦ Psychosocial problems
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Medical Complications
Ask Permission

Get the story
Examine the skin
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Paint the Picture
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Body Art……
Alert
Risky behavior….
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Armstrong ML, DeBoer S, Cetta F. Infective endocarditis after body
art: a review of the literature and concerns. J Adolesc Health.
2008;43(3):217-225.
Braverman PK. Body Art:piercing,tattooing, and scarification.
Adolesc Med Clin. 2006;17(3):505-519
Benjamins LJ, etal. Body Art among minority high school athletes:
prevalence, interest and satisfaction; parental knowledge and
consent. J Adolesc Health. 2006;39(6):933-935.
Carroll ST, etal. Tattoos and Body Piercings as indicators of
adolescent risk-taking behaviors. Pediatrics. 2002;109:10211027.
Hinz HA. Tattoos, body piercings, and self injury: is there a
connection? Investigations on a core group of participants
practicing body modification. Psychother Res. 2008;18(3):326333.
Lane JE, Waller JL, Davis LS. Relationship between age of ear
piercing and keloid formation. Pediatrics. 2005;115:1312-1314.
Larzo MR, Poe SG. Adverse consequences of Tattoos and Body
Piercings. Pediatric Annals. 2006;35(3): 187-192.
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Laumann AE, Derick AJ. Tattoos and body piercings in the United
States: a national data set. J AM Acad Dermatol. 2006;55(3):413421.
Mayers LB, Chiffriller SH. Body Art (body piercing and tattooing)
among undergraduate university students: “then and now”. J
Adolesc Health. 2008;42(2):201-203.
Mayers LB, etal. Tattooing and Body Piercing. Pediatrics.
2003:111:1126Meltzer DI. Complications of Body Piercing. American Family
Physician. 2005;72(10):2029-2034.
Muensterer OJ. Temporary removal of naval piercing jewelry for
surgery and imaging studies. Pediatrics. 2004;114;e384-e386.
Navarro DS. What teens should know about oral piercings. School
Nurse News. 2008;25(5):25-26.
Roberts TA, Ryan SA. Tattooing and High-Risk behavior in
Adolescents. Pediatrics. 2002;110:1058-1063.
Schmidt RM, Armstrong ML. Tattooing and body piercing.
UpToDate. ; www.uptodate.com