A rapid review of physical health risks associated with special procedures (tattooing, body piercing, acupuncture, electrolysis)
Background and Context
More and more people in the UK are getting tattoos (including semi-permanent make-up), piercings, acupuncture, and electrolysis. Known as 'special procedures' under the Public Health (Wales) Act 2017, they can be associated with some health risks. Inflammation and infection can occur as needles and other products are inserted into the skin. In rare cases, the procedures can cause serious and long-term diseases.
The Act sets out provisions for a mandatory licensing scheme for those individuals and businesses providing these procedures in Wales.. The licensing scheme, when it is introduced in 2024, will ensure that all licence holders and approved businesses operate to a safe and consistent standard.
Aims
We aimed to collect existing published evidence on the main physical health risks associated with special procedures. This review updates previous evidence used by the Welsh Government and serves to endorse the implementation of the new licensing scheme.
Method
The research team looked at existing literature on this topic, including ‘systematic reviews’ and other primary studies published between 2015 and 2023 that described adverse reactions following special procedures.
Outcomes
The main outcomes =looked at were adverse reactions. There are two types:
- Microbiological reactions caused by microorganisms. A range of bacterial, viral, and fungal infections were seen associated with tattoos, piercings, and acupuncture.
- Non-microbiological reactions include allergic reactions, harmless and cancerous growths, or long-term inflammation. This type of reaction was seen in all four procedures.
Some reactions were seen immediately after the procedure, and some were seen years later. There was a lack of evidence on electrolysis compared to the other procedures.
Most of the primary research in the systematic reviews talks about individual cases, although the studies themselves were not always high-quality.
Impact
This study has shown there is a link between special procedures and adverse reactions, further endorsing the requirements of Part 4 of the Public Health (Wales) Act 2017. This in turn has helped inform the development of the 5 sets of regulations currently in draft and will support the development of the accompanying non-statutory guidance.
Further research
Further research employing more robust designs would be needed to gather evidence around causal links between special procedures and adverse health events, as well as prevalence of such events.
More evidence is also needed to identify physical health risks associated with electrolysis.
Author: Praveena Pemmasani
RR0018