The DO | Special Coverage | OMED 2013

The girl with the infected dragon tattoo: Healing body art gone awry

Brock Generalovich, DO, doesn’t have any tattoos, and he doesn’t want any. But the plastic surgeon from Boardman, Ohio, sees them frequently on his patients, whether he’s removing one or treating a tattoo-caused infection. And in the operating room recently, Dr. Generalovich was chatting with his surgery team about tattoos. He learned that aside from himself, everyone in the room—five esteemed professionals—had ink.

Brock Generalovich, DO

When patients say they’re going to get a tattoo or a body piercing, Brock Generalovich, DO, recommends prescribing prophylactic antibiotics. (Photo by Patrick Sinco)

“Every one of them is a mom, and every single one of them has a tattoo,” he said. “This is not something that is just for bikers or for rebels.”

About 23% of Americans have tattoos, and nearly 40% of millennials are inked, according to 2010 data from the Pew Research Center.

Tattoos and piercings are increasingly common, and when patients suffer complications from them, they will often reach out to their primary care physician first, Dr. Generalovich said in an OMED session Wednesday. For this reason, family physicians should familiarize themselves with tattoos and piercings and accept them as a viable form of self-expression, he noted. Dr. Generalovich also suggested that family physicians provide an accepting space where patients feel comfortable discussing their tattoos. Coming across as judgmental or condescending could compromise patient safety if the patient feels uneasy about disclosing information.

“It can even be a part of the [form patients fill] out when they come in and they’re waiting in the waiting room,” Dr. Generalovich said. ” ‘Do you have any tattoos or piercings?’ Just put that on there, and then you don’t have to ask those tough questions.”

Common medical complications of tattoos include infections, skin disorders and allergic reactions, Dr. Generalovich said. Infections are most common and can be treated like burns, Dr. Generalovich said. He also said he doesn’t skimp on antibiotics because he often doesn’t see patients until after the problem has been festering for about a week.

“I typically put [patients] on a double antibiotic regimen,” he said, noting that the cocktail usually includes cephalexin and a combination of sulfamethoxazole and trimethoprim.

In treating tattoo complications, Dr. Generalovich also recommended identifying wound risk factors, such as smoking and nutrition; providing the patient proper instruction on wound dressing; and following up with the patient to make sure the wound is healing properly.

“At three days, if the problem is the same and hasn’t worsened, then we’re going to be OK,” he said. “If you see [the patient] in another three days and it hasn’t started to get better, then you have to do something different.”

The change in treatment might involve switching or increasing the antibiotics or putting the patient in the hospital to receive IV antibiotics and care from an infectious disease specialist, depending on the size and significance of the wound, Dr. Generalovich said.

And when it comes to piercings, patients most frequently suffer from infection, trauma and allergic reaction at the site of the piercing, Dr. Generalovich said. In treating these wounds, physicians should remove the jewelry, culture the wound, provide broad-spectrum antibiotic coverage, and debride and cleanse necrotic or traumatized tissue. As with tattoo complications, piercing wounds should be closely watched and properly dressed.

Occasionally, a patient will share his or her intentions to get a tattoo or a body piercing. In these cases, Dr. Generalovich recommended prescribing prophylactic antibiotics.

“We ‘prophylax’ people for surgical procedures,” he said. “These are sometimes crazily invasive procedures, and they’re not being done in an operating room where it’s clean.”

Attendee Todd M. Podkowka, DO, says he appreciated this advice because he has performed the same service for his patients.

“If you know someone’s going to get a tattoo, I think the best thing to do is to give him or her a prescription for an antibiotic,” said Dr. Podkowka, a family physician from Lee Center, N.Y. “There aren’t very many high-end tattoo parlors, or tattoo parlors that I would trust, around where I practice.”

Dr. Podkowka also liked Dr. Generalovich’s suggestion to include a question about tattoos and piercings on the standard patient introduction form. After seeing one patient in particular, Dr. Podkowka began asking all his patients this question as well.

“I had a patient one time who was in his 50s,” he said. “I was doing a whole physical exam on him, so I had to do a testicular exam. He dropped his pants, and he had his genitalia pierced. I wasn’t expecting that from him. It kind of shocked me. I guess you can never stereotype somebody, because this guy looked like a businessman. It kind of opened my eyes and made me think that I should ask everybody about tattoos and piercings.”

One Response

  1. Anthony, OMS-II on Oct. 11, 2013, 3:31 p.m.

    This article brings up a very important topic regarding what many people within my age group love to do, myself included, and receive a tattoo or body piercing. It is of significant importance to remember this in the practice of a physician today.
    I also think it is very important, as this article did, to remember not to be judgmental towards the patient either inwardly or outwardly. The second a patient may feel as if there is judgement, the trust, and potentially the subsequent medical care, will be severely harmed.
    I think it is also important to remember that certain states have stricter laws than others. As a Virginia native, I found it shocking that the state in which I currently reside has much less strict laws regarding tattoo parlors. I became aware of this fact when I started digging into why Red Cross blood donor rules are different for tattoo obtained in different states.
    As a physician is asking these questions, it is important to remember that tattoo and piercings are not just associated with sailors and biker gangs, but also many people around you, maybe even a colleague that you work beside. This will begin to happen more and more as young newly graduated medical students enter the hospitals as doctors rather than medical students. For this reason, and for the safety of the patient, while asking these questions one must remain open minded and nonjudgmental.

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