A rapid review of physical health risks associated with special procedures (tattooing, body piercing, acupuncture, electrolysis)

Special procedures, such as tattooing (including semi-permanent make-up), body piercing, acupuncture and electrolysis involve piercing the skin and carry a potential risk of infection and other complications. This review provides an up-to-date evidence base on the main physical health risks associated with these special procedures. Searches were conducted for research published between 2015 and 2023. Where possible, existing reviews were used. For tattooing, one systematic review including 55 studies was identified. For semi-permanent make-up, 37 cases presented in 31 case reports were identified. For body piercing, four systematic reviews were identified, which covered 174 studies. For acupuncture, one evidence map of 535 systematic reviews without age limits and one overview of 24 systematic reviews focused on children were included. For electrolysis, one case report was identified. Complications and adverse events resulting from special procedures include fungal infections, bacterial infections, viral infections, blood-borne infections, allergic reactions, malignant growths, benign growths, sarcoidosis-related reactions, and a range of other skin and eye-related adverse reactions and dental issues. Research Implications and Evidence GapsMost of the primary evidence for the physical health risks associated with the special procedures came from case reports and case series, which do not allow causal inferences or provide information on the prevalence of adverse events. Future primary research should employ more robust designs to gather evidence about the causal links between special procedures and adverse physical health events as well as about the prevalence of such events in people receiving special procedures. More evidence is needed to identify physical health risks associated with electrolysis. Policy and Practice ImplicationsThe evidence contained in this review will be used to inform the training of local authority enforcement officers and special procedures practitioners and to educate members of the public who seek to use these services. Due to the nature of the special procedures which involves piercing the skin and poses the risk of introducing infections to the body, high standards of hygiene may reduce the rate of infection. Funding statementThe Wales Centre for Evidence Based Care, and the Specialist Unit for Review Evidence, were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.