As a form of self-expression, body art is becoming a familiar sight. Just visit Portland's Pioneer Courthouse Square and you will see an amazing array of pierced lips, noses, eyebrows, navels and more.

Many people have multiple earrings. Others have nose rings, eyebrow rings, pierced cheeks, lips and tongues as well as pierced nipples, navels and genitals. No statistics are kept, so no one knows what percentage of Americans have body piercings, but health care providers and dentists say the numbers are growing steadily.

Some people get pierced just because they like the way it looks, and they see it as a way to adorn and beautify their bodies. Some piercings (nipples, genital and tongue) are done to increase sexual stimulation. Body piercing is less permanent than tattooing, since most piercings can be removed and the skin will heal over with minimal scarring.

The main health concerns related to piercings include bleeding, infection, scarring, allergic reactions, chipped teeth (with pierced tongues) and increased risk of sexually transmitted diseases (with genital piercings).

People with certain medical problems should not get pierced. The list is nearly identical to the list of those who should not get a tattoo. This includes anyone with bleeding problems such as hemophilia, those who take blood thinners, people with suppressed immune systems and pregnant women. Diabetics or anyone with an active disease should consult with their doctors before getting pierced. If you have mitral valve prolapse or another heart defect, consult your doctor about taking antibiotics when you get pierced to reduce your risk of endocarditis. Additionally, people who tend to form keloids when they scar run the risk of a keloid forming around their piercing.

Here is another health issue to consider. If you ever need an MRI scan, you will need to remove all your piercings since metallic objects are hazardous in the strong magnetic field of the scanner.

Another concern is that body piercers are not licensed by the state, meaning that you can't be certain that they are knowledgeable about anatomy and the prevention of infections. The best way to assess whether or not piercers are qualified is to ask about their training and experience.

Body piercing shops should be clean and well-lighted. The shop must have an autoclave to sterilize equipment. They should never use spring-loaded guns ("ear guns" such as those used at piercing kiosks in shopping malls) since these can't be completely sterilized and can transmit blood-borne diseases. They should use brand-new needles that are opened in front of you immediately before piercing. The piercer should wear gloves while working.

Jewelry used for piercing must be one of these types: 14- or 18-karat solid gold, stainless steel, titanium or niobium. Jewelry of low quality, particularly if it contains nickel, can cause allergic reactions. Many people who think their piercings are chronically infected because they are red actually have an allergy to their jewelry.

A new, healing piercing should be thought of as an open wound, prone to infection. New body piercings can take a long time to heal completely, and require a lot of care.

To care for a new piercing: wash your hands before and after touching the piercing. Soak the pierced area with warm water for a few minutes to loosen any dried secretions, then clean the area with antibacterial soap twice a day; rinse well. Rotate the jewelry while cleaning. Dry the area with clean paper tissue. Do not use rubbing alcohol, which is too drying. Also, do not use antibacterial or other ointments. Soak the piercing in a salt-water solution (a pinch of sea salt per one cup warm water) at least once a day.

Pain, redness, swelling and pus coming from the site of the piercing are signs of infection. Infections anywhere on the face or head are particularly dangerous as they can spread to the brain.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send your idea to

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