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  • Tattoos, piercings, and scarifications are forms of body modification that date back thousands of years.

  • Trends in tattooing have shifted from abstract images obtained for religious and ceremonial purposes, to the depiction of literal images that are often the result of a random, impulsive act.

  • It is estimated that 13% of the American population has at least one tattoo and 35% have piercings.

  • In the United States, tattoo pigments are classified as cosmetics and are approved only for topical use under the Food, Drug, and Cosmetic Act of 1938; these pigments are not for intradermal injection.

  • Common reactions to both tattoos and piercings include infection (viral and bacterial), hypersensitivity reactions, localization of various dermatoses, and scarring.



For centuries, humans have adorned themselves with various forms of body art. Practices such as tattooing, scarification, branding, piercing, and body painting are performed to express individualism, mark rites of passage, substantiate group membership, and serve as ritualistic symbols [Figure 36-1].

FIGURE 36-1.

Scarification on an Ethiopian woman. (Used with permission from Jodi Cobb/National Geographic Creative.)

The term tattoo comes from the Tahitian word tatau meaning “to mark.”1,2 Tattooing is a form of body modification that typically uses needles to inject pigment into the dermal layer of the skin. However, there are various types of tattoos ranging from temporary henna tattoos and body painting to the permanent decorative and makeup tattoos using the dermal injection of pigment.

Numerous tombs have been unearthed revealing mummies with intact tattoos and, interestingly, pictures on the walls of the tomb that depict humans with tattoos. Ancient tattoos such as Egyptian, Aboriginal, and Japanese, are generally abstract and primarily composed of geometric shapes, dots, and lines that have personal or nonfigurative meanings. Māori culture in New Zealand traditionally attributes spiritual and cultural significance to certain words, images, and patterns, as all cultures do. Ta moko, traditional Māori tattooing, often on the face, is a taonga (treasure) to Māori for which the purpose and applications are sacred [Figure 36-2]. Every moko contains ancestral/tribal messages specific to the wearer. These messages tell the story of the wearer’s family and tribal affiliations and the wearer’s place in these social structures. A moko’s message would also contain the wearer’s ‘value’ by way of their genealogy and their knowledge and standing in their social level. Ta moko as an art form declined during the twentieth century; however, recently it has been revived as an important art form among Māori that is worn as an expression of cultural pride and integrity.3 This is in contrast to modern Western tattooing practices that tend to use literal images such as flowers, butterflies, and trademarked animated characters.4,5 Many attribute this ...

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