Tattoos, piercing, and scarification are now commonplace among adolescents and young adults. This first clinical report from the American Academy of Pediatrics on voluntary body modification will review the methods used to perform the modifications. Complications resulting from body modification methods, although not common, are discussed to provide the pediatrician with management information. Body modification will be contrasted with nonsuicidal self-injury. When available, information also is presented on societal perceptions of body modification.

  • Abbreviations:
    G6PDglucose-6-dehydrogenase
    NSSInonsuicidal self-injury
    NTMnontuberculous mycobacteria
    PPDparaphenylenediamine

Tattoos, piercings, and scarification, also known as “body modifications,” are commonly obtained by adolescents and young adults. Previous reports on those who obtain tattoos, piercings, and scarification have focused mainly on high-risk populations, including at-risk adolescents.1 Tattooing and piercing of various body parts no longer is a high-risk–population phenomenon, as evidenced by growing numbers of adults and adolescents not considered at risk who have tattoos and multiple ear and body piercings. The Pew Research Center reports that in 2010, 38% of 18 to 29 year olds had at least 1 tattoo, and 23% had piercings in locations other than an earlobe.2 Of those with tattoos, 72% were covered and not visible.2 Scarification is the practice of intentionally irritating the skin to cause a permanent pattern of scar tissue; data are not currently available on the prevalence of scarification in the United States.

Although body modifications have become a mainstream trend, they still may be associated with medical complications and, among adolescents, may also co-occur with high-risk behaviors. This first clinical report from the American Academy of Pediatrics on tattooing, piercing, and scarification discusses the history of these methods of body modification, educates the reader on methods used, reports on trends in associated adolescent and young adult risk behaviors, differentiates between nonsuicidal self-injury (NSSI) and body modifications, and educates the reader about how to anticipate and prevent potential medical complications. The report analyzes the literature about societal acceptance of people with body modifications and perceptions that might potentially interfere with adolescents’ and young adults’ educational and career plans. Finally, guidance is provided to pediatricians and, through the pediatrician, to parents and adolescents and young adults about safety and regulations regarding body modification should they wish to obtain tattoos, piercings, or scarification.

History of Body Modification: Tattooing, Piercing, and Scarification

Although interest in body modification has increased recently, history teaches us that body modifications are not new. Archeologists have found evidence of tattoos, piercings, and scarification as far back as 2000 BC, when they were largely used as a form of art or to identify group membership, such as a religious group or tribe. Although mostly used to describe loyalty, interests, and lifestyle choices, body modification had also been used to label criminals, slaves, and convicts.3

Although in the late 20th century, most tattoos were on men, ranging from the stereotypical tattooed sailors and motorcycle bikers (eg, The Hells Angels in the 1960s) to 1980s gang members, now, tattoos are collections of colorful ornamentations for both women and men. Surveys of the US population have shown an increase in the prevalence of tattoos over time.4,5

Tattoos, piercing, and scarification are now commonplace among adolescents and young adults. This first clinical report from the American Academy of Pediatrics on voluntary body modification will review the methods used to perform the modifications. Complications resulting from body modification methods, although not common, are discussed to provide the pediatrician with management information. Body modification will be contrasted with nonsuicidal self-injury. When available, information also is presented on societal perceptions of body modification.

  • Abbreviations:
    G6PDglucose-6-dehydrogenase
    NSSInonsuicidal self-injury
    NTMnontuberculous mycobacteria
    PPDparaphenylenediamine

Tattoos, piercings, and scarification, also known as “body modifications,” are commonly obtained by adolescents and young adults. Previous reports on those who obtain tattoos, piercings, and scarification have focused mainly on high-risk populations, including at-risk adolescents.1 Tattooing and piercing of various body parts no longer is a high-risk–population phenomenon, as evidenced by growing numbers of adults and adolescents not considered at risk who have tattoos and multiple ear and body piercings. The Pew Research Center reports that in 2010, 38% of 18 to 29 year olds had at least 1 tattoo, and 23% had piercings in locations other than an earlobe.2 Of those with tattoos, 72% were covered and not visible.2 Scarification is the practice of intentionally irritating the skin to cause a permanent pattern of scar tissue; data are not currently available on the prevalence of scarification in the United States.

Although body modifications have become a mainstream trend, they still may be associated with medical complications and, among adolescents, may also co-occur with high-risk behaviors. This first clinical report from the American Academy of Pediatrics on tattooing, piercing, and scarification discusses the history of these methods of body modification, educates the reader on methods used, reports on trends in associated adolescent and young adult risk behaviors, differentiates between nonsuicidal self-injury (NSSI) and body modifications, and educates the reader about how to anticipate and prevent potential medical complications. The report analyzes the literature about societal acceptance of people with body modifications and perceptions that might potentially interfere with adolescents’ and young adults’ educational and career plans. Finally, guidance is provided to pediatricians and, through the pediatrician, to parents and adolescents and young adults about safety and regulations regarding body modification should they wish to obtain tattoos, piercings, or scarification.

History of Body Modification: Tattooing, Piercing, and Scarification

Although interest in body modification has increased recently, history teaches us that body modifications are not new. Archeologists have found evidence of tattoos, piercings, and scarification as far back as 2000 BC, when they were largely used as a form of art or to identify group membership, such as a religious group or tribe. Although mostly used to describe loyalty, interests, and lifestyle choices, body modification had also been used to label criminals, slaves, and convicts.

Although in the late 20th century, most tattoos were on men, ranging from the stereotypical tattooed sailors and motorcycle bikers (eg, The Hells Angels in the 1960s) to 1980s gang members, now, tattoos are collections of colorful ornamentations for both women and men. Surveys of the US population have shown an increase in the prevalence of tattoos over time.