The art of tattooing and the practice of body piercing go back thousands of years. A tattoo is an image made by permanent ink placed directly under the outermost layer of your skin, the epidermis, into the dermis. Tattoos range from permanent eyeliner or eyebrows to full arm sleeves and more. Regardless of the type of permanent tattoo, in order for the ink or dye to get under the skin, the tattoo artist must make thousands of tiny holes or pin pricks to make openings for the ink to enter. Until each one of these tiny holes in the skin heals, they make you susceptible to infection.

A body piercing involves creating an opening in your skin or cartilage so you can insert a piece of jewelry. Piercings can be done just about anywhere, from the more traditional ear lobes to other parts of the body, such as the tongue, navel, and even genitals. These breaks in the skin are, as with tattoos, a source for infection until they are fully healed. Depending on the location of the piercings, some are also easier to tear or chafe even after they have healed, which again makes them susceptible to infection. This includes infections such as cellulitis and necrotizing fasciitis.

If you are considering a tattoo or body piercing, there are some steps you can take before you get the tattoo and after to reduce the risk of contracting an infection .

• Choose a reputable artist. Ask for recommendations. If you have friends or family members with tattoos or piercings you like, ask if they would recommend the studio and artist again. Ask about their experiences and if they have ever had an infection or problem following the procedure.
• Check to see if your state or local region regulates shops and studios that offer tattoos or piercings. Not all states have this requirement. Check for how many years the artist has been in business.
• Visit the studio or shop. Look for signs of proper cleaning and maintenance. Ask questions about what type of equipment the artists use. You are looking for artists who use single, “throw away” kits. For tattoos, these contain disposable needles and tubes, and for piercings they contain needles. Does the staff use an autoclave to sterilize non-disposable equipment? Check to see where they place their used needles. The shop or studio must have a separate, clearly marked red container marked “sharps disposal.” Razors must also be disposable. The artist should also wash their hands and use a new pair of sterile disposable gloves before touching a new client or if they step away and return to continue the procedure. If these basic steps of infection control are not present, go to another establishment.
• Do not use a DIY tattoo kit. The Food and Drug Administration (FDA) recommends against using do-it-yourself kits for tattoos. The inks are associated with infections and allergic reactions, and the agency is concerned that tattoos done at home may not follow all infection-prevention strategies. Self-piercing is also discouraged because of the increased risk of infection when a piercing is not done in the proper environment.
• Sterilize jewelry before insertion into the new hole.

Even if you have had multiple piercings or tattoos and you’ve never had an infection before, you still must follow the after-care instructions every time you have a body modification. It’s important to keep in mind that no two tattoos or piercings heal at the same rate.

Tattoos

You should receive instructions on how to care for the tattoo until it has healed. These are the most common instructions:

• Once complete, your artist should wrap your tattoo to keep it clean and prevent it from rubbing against your clothing or coming into contact with some other objects that could irritate the skin further or introduce germs. Your tattoo artist will tell you how long to keep the new art covered, which is usually about 24 hours.
• Once you remove the covering, you should gently clean the tattoo with warm water and unscented soap. Always make sure you have washed your hands before touching your tattoo. Pat your skin dry with a clean towel you don’t share with someone else – do not rub. Rubbing may affect the tattoo and it may cause more irritation to the skin as well. You may want to apply some antibiotic ointment.
• If any scabs form, do not pick at them.
• Avoid swimming, using a hot tub, or getting the tattoo wet other than with regular washing. Wait until the skin has healed.
• If you show any signs of infection, see your doctor or nurse practitioner right away, or go to an urgent care clinic. Signs include skin getting redder around the tattoo, redness spreading, increased pain, pus from the tattoo, fever.

Piercings

As with tattoos, follow the after-care instructions for your particular piercing. Always wash your hands before handling your piercing. The instructions usually include:

• If you have had an oral piercing, use a new soft bristle toothbrush. This avoids introducing bacteria from an older brush into your piercings. The piercing also needs to be cleaned with an alcohol-free antiseptic mouthwash after you eat and before bed. Swish the mouthwash for 30 seconds to a minute. You can also rinse twice a day with a salt-water rinse, about a quarter of a teaspoon of table salt dissolved in a cup of warm water. After the piercing heals remember to take out the jewelry every night to clean it. This prevents plaque from building up.
• For skin piercings, clean the site a few times a day. Use a salt water solution or warm water and non-scented soap. Do not go swimming, use a hot tub, or expose your piercing to water other than to clean it until the skin has healed. Don’t remove the piercing until the skin has healed.*
• For all piercings, it is important to not touch, twist, or fiddle with the jewelry as the hole heals.
• If you show any signs of infection, see your doctor or nurse practitioner right away. An urgent care clinic is another option. Signs include skin getting redder around the piercing, swelling, increased pain, pus or discharge, fever.

*If you develop an infection, you may need to remove the jewelry in order to treat the infection effectively.

You may need an antibiotic cream first. You might get oral antibiotics if the infection is more serious or in a place where it is impossible to apply a cream. Follow the instructions for the antibiotics to work. You may have to remove your piercing

Once the tattoo or piercing is healed, the skin is intact and should not be at risk for infection any more. However, some types of body piercings are at a higher risk of injury and infection well after the piercing has healed. Earrings can rip accidentally from an ear lobe. Navel piercings can become irritated and raw from rubbing against clothing. If you have a piercing, always be aware of the signs and symptoms of an infection.