History and Epidemiology of Tattoos and Piercings: Legislation in the United States and in Europe

  • Anne E. LaumannEmail author
  • Nicolas Kluger


Tattooing and body piercing date back to early civilizations. In the past they were used during initiation rites or as an indication of social status. Not only has tattooing been used for medical purposes, decoration, and to mark group affiliation but also to identify criminals, prisoners, and slaves and for punishment. On the other hand, body piercing has a more limited history, although there is evidence, in ancient societies, of its use in the soft earlobe, lower lip, and nasal septum for the insertion of decorative pieces, as well as its use in the genital area for sexual inhibition or pleasure. It was hardly seen before the end of the 1980s in the advanced world. In general, it is still more common among women than men. These two forms of body modification may have different underlying motivations as fewer than a third of those with tattoos and half of those with body piercings have the other. Encouraged by modern sophisticated techniques and the absence of a widespread easily recognized downside, both activities have become increasingly common in the general population. At the same time, concern has increased related to associated social and medical issues both in the United States and more so in Europe. This has led to increased legislative attempts, often not enforced, in many countries related to the tattooing and body piercing of minors; the information, written and verbal, given to clients prior to the activity; the training and background of tattooists; the composition and sterility of materials inserted into the skin; and the hygiene of the studios.


Tattooing Body piercing Epidemiology Public health Legislation 


  1. 1.
    Sperry K (1991) Tattoos and tattooing. Part I: History and methodology. Am J Forensic Med Pathol 12:313–319CrossRefPubMedGoogle Scholar
  2. 2.
    Dorfer L, Moser M, Bahr F et al (1999) A medical report from the stone age? Lancet 354:1023–1025CrossRefPubMedGoogle Scholar
  3. 3.
    Lowenstein EJ (2004) Paleodermatoses: lessons learned from mummies. J Am Acad Dermatol 50:919–936CrossRefPubMedGoogle Scholar
  4. 4.
    Isaiah (44:5) The BibleGoogle Scholar
  5. 5.
    Leviticus (19:28) The Bible: King James VersionGoogle Scholar
  6. 6.
    Scheinfeld N (2007) Tattoos and religion. Clin Dermatol 25:362–366CrossRefPubMedGoogle Scholar
  7. 7.
    Reed C (2000) Tattoo in early China. J Am Orient Soc 120:360–376CrossRefGoogle Scholar
  8. 8.
    Demello M (2007) Encyclopedia of body adornment. Greenwood Press, WestportGoogle Scholar
  9. 9.
    Rockwell N (1944) Cover page. Saturday Evening Post, vol 216, p 1Google Scholar
  10. 10.
    Wolf EK, Laumann AE (2008) The use of blood-type tattoos during the cold war. J Am Acad Dermatol 58:472–476CrossRefPubMedGoogle Scholar
  11. 11.
    Papachristos A (2005) Gang world. Foreign Policy 147:49–55Google Scholar
  12. 12.
    Steward S (1990) Bad boys and tough tattoos. Harrington Park Press, BinghamtonGoogle Scholar
  13. 13.
    Beckwith C, Fisher A (1991) The eloquent surma of Ethiopia. Natl Geogr Mag 179:77–91Google Scholar
  14. 14.
    Waugh M (2007) Body piercing: where and how. Clin Dermatol 25:407–411CrossRefPubMedGoogle Scholar
  15. 15.
    Daniélou A (1994) The complete kama sutra. Part Street Press, RochesterGoogle Scholar
  16. 16.
    Ng KH, Siar CH, Ganesapillai T (1997) Sarcoid-like foreign body reaction in body piercing: a report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:28–31CrossRefPubMedGoogle Scholar
  17. 17.
    Gröning K (2002) Decorated skin. Thames and Hudson, New YorkGoogle Scholar
  18. 18.
    Kanee B (1950) Technic of ear piercing. Arch Derm Syphilol 61:502CrossRefPubMedGoogle Scholar
  19. 19.
    Lerner C (1932) History of feminine beautification. Arch Derm Syphilol 26:1022–1031CrossRefGoogle Scholar
  20. 20.
    Stirn A (2003) Body piercing: medical consequences and psychological motivations. Lancet 361:1205–1215CrossRefPubMedGoogle Scholar
  21. 21.
    Laumann AE, Derick AJ (2006) Tattoos and body piercings in the United States: a national data set. J Am Acad Dermatol 55:413–421CrossRefPubMedGoogle Scholar
  22. 22.
    Kluger N (2015) Epidemiology of tattoos in industrialized countries. Curr Probl Dermatol 48:6–20CrossRefPubMedGoogle Scholar
  23. 23.
    Piccinini P, Bianchi I, Pakalin S, Senaldi C (2015) Safety of tattoos and permanent make-up Compilation of information on legislative framework and analytical methods. Report on Work Package 1 Administrative Arrangement N. 2014-33617 Analysis conducted on behalf of DG JUST. Joint Research Centre. European Union, 2015. Report EUR 27394 EN.
  24. 24.
    Fourquet J (2010) Les francais et les tatouages.
  25. 25.
    Fourquet J (2017) Les francais et les tatouages.
  26. 26.
    Kluger N (2015) Tattooed people, who are you? Demographic and behavioral characteristics of tattooed individuals. Ann Dermatol Venereol 142:410–420CrossRefPubMedGoogle Scholar
  27. 27.
    Armstrong ML (1991) Career-oriented women with tattoos. Image J Nurs Sch 23:215–220CrossRefPubMedGoogle Scholar
  28. 28.
    Armstrong ML, Saunders JC, Roberts AE (2009) Older women and cosmetic tattooing experiences. J Women Aging 21:186–197CrossRefPubMedGoogle Scholar
  29. 29.
    Klügl I, Hiller KA, Landthaler M, Bäumler W (2010) Incidence of health problems associated with tattooed skin: a nation-wide survey in German-speaking countries. Dermatology 221:43–50CrossRefPubMedGoogle Scholar
  30. 30.
    Kluger N (2016) Tattooing in Finland: a survey in a tattoo convention. Forum Nordic Derm Venereol 21:62–66Google Scholar
  31. 31.
  32. 32.
    Armstrong ML (1994) Adolescents and tattoos: marks of identity or deviancy? Dermatol Nurs 6:119–124PubMedGoogle Scholar
  33. 33.
    Brooks TL, Woods ER, Knight JR et al (2003) Body modification and substance use in adolescents: is there a link? J Adolesc Health 32:44–49CrossRefPubMedGoogle Scholar
  34. 34.
    Carroll L, Anderson R (2002) Body piercing, tattooing, self-esteem, and body investment in adolescent girls. Adolescence 37:627–637PubMedGoogle Scholar
  35. 35.
    Ceniceros S (1998) Tattooing, body piercing, and Russian roulette. J Nerv Ment Dis 186:503–504CrossRefPubMedGoogle Scholar
  36. 36.
    Drews DR, Allison CK, Probst JR (2000) Behavioral and self-concept differences in tattooed and nontattooed college students. Psychol Rep 86:475–481CrossRefPubMedGoogle Scholar
  37. 37.
    Armstrong ML, Murphy KP, Sallee A et al (2000) Tattooed army soldiers: examining the incidence, behavior, and risk. Mil Med 165:135–141CrossRefPubMedGoogle Scholar
  38. 38.
    Stephens MB (2003) Behavioral risks associated with tattooing. Fam Med 35:52–54PubMedGoogle Scholar
  39. 39.
    Healy B (2008) The dangerous art of the tattoo. US News World Rep 145:69PubMedGoogle Scholar
  40. 40.
    Liszewski W, Jagdeo J, Laumann A (2016) The need for greater regulation, guidelines and a consensus statement for tattoo aftercare. JAMA Dermatol 152(2):141–142CrossRefPubMedGoogle Scholar
  41. 41.
    Haugh IM, Laumann SL, Laumann AE (2015) Regulation of tattoo ink production and the tattoo business in the U.S. in tattooed skin and health. In: Serup J, Kluger N, Bäumler W (eds) Current problems in dermatology. Karger, BaselGoogle Scholar
  42. 42.
    Silvers DN, Gelb H (1991) The prohibition of tattooing in New York city. Am J Dermatopathol 13:307–309CrossRefPubMedGoogle Scholar
  43. 43.
    Goldstein N (1979) Laws and regulations relating to tattoos. J Dermatol Surg Oncol 5:913–915CrossRefPubMedGoogle Scholar
  44. 44.
    Tope WD (1995) State and territorial regulation of tattooing in the United States. J Am Acad Dermatol 32:791–799CrossRefPubMedGoogle Scholar
  45. 45.
    National Environmental Health Association? (1999) Body art: a comprehensive guidebook and model code. National Environmental Health Association, DenverGoogle Scholar
  46. 46.
    Armstrong ML (2005) Tattooing, body piercing, and permanent cosmetics: a historical and current view of state regulations, with continuing concerns. J Environ Health 67:38–43, 54, 53PubMedGoogle Scholar
  47. 47.
    Resolution ResAP (2008)1 on requirements and criteria for the safety of tattoos and permanent make-up (superseding Resolution ResAP(2003)2 on tattoos and permanent make-up).
  48. 48.
  49. 49.
    Piccinini P, Pakalin S, Contor L, Bianchi I, Senaldi CO (2016) Safety of tattoos and permanent make-up: Final report. Administrative Arrangement N. 2014-33617 Analysis conducted on behalf of DG JUST. European Union, 2016.
  50. 50.
    Roberts TA, Ryan SA (2002) Tattooing and high-risk behavior in adolescents. Pediatrics 110:1058–1063CrossRefPubMedGoogle Scholar
  51. 51.
    Rooks JK, Roberts DJ, Scheltema K (2000) Tattoos: their relationship to trauma, psychopathology, and other myths. Minn Med 83:24–27PubMedGoogle Scholar
  52. 52.
    Mayers LB, Judelson DA, Moriarty BW et al (2002) Prevalence of body art (body piercing and tattooing) in university undergraduates and incidence of medical complications. Mayo Clin Proc 77:29–34CrossRefPubMedGoogle Scholar
  53. 53.
    Carroll ST, Riffenburgh RH, Roberts TA et al (2002) Tattoos and body piercings as indicators of adolescent risk-taking behaviors. Pediatrics 109:1021–1027CrossRefPubMedGoogle Scholar
  54. 54.
    Mayers LB, Chiffriller SH (2008) Body art (body piercing and tattooing) among undergraduate university students: “then and now”. J Adolesc Health 42:201–203CrossRefPubMedGoogle Scholar
  55. 55.
    Pew Research Center (2007) How young people view their lives, futures and politics. Pew Research Center, Washington, DCGoogle Scholar
  56. 56.
  57. 57.
    Stirn A, Brahler E, Hinz A (2006) Prevalence, sociodemography, mental health and gender differences of tattooing and body piercing. Psychother Psychosom Med Psychol 56:445–449CrossRefPubMedGoogle Scholar
  58. 58.
    Stirn A, Hinz A, Brahler E (2006) Prevalence of tattooing and body piercing in Germany and perception of health, mental disorders, and sensation seeking among tattooed and body-pierced individuals. J Psychosom Res 60:531–534CrossRefPubMedGoogle Scholar
  59. 59.
    Preti A, Pinna C, Nocco S et al (2006) Body of evidence: tattoos, body piercing, and eating disorder symptoms among adolescents. J Psychosom Res 61:561–566CrossRefPubMedGoogle Scholar
  60. 60.
    Myllyniemi S. Taidekohtia (2009) Nuorisobarometri. Helsinki: Yliopistopaino Oy. 205p. https://tietoanuorista./wp-content/uploads/2013/05/Nourisobarometri_2009.pdfGoogle Scholar
  61. 61.
    Deschesnes M, Demers S, Fines P (2006) Prevalence and characteristics of body piercing and tattooing among high school students. Can J Public Health 97:325–329PubMedGoogle Scholar
  62. 62.
    Deschesnes M, Fines P, Demers S (2006) Are tattooing and body piercing indicators of risk-taking behaviours among high school students? J Adolesc 29:379–393CrossRefPubMedGoogle Scholar
  63. 63.
    Makkai T, McAllister I (2001) Prevalence of tattooing and body piercing in the Australian community. Commun Dis Intell 25:67–72Google Scholar
  64. 64.
    Oliveira MD, Matos MA, Martins RM et al (2006) Tattooing and body piercing as lifestyle indicator of risk behaviors in Brazilian adolescents. Eur J Epidemiol 21:559–560CrossRefPubMedGoogle Scholar
  65. 65.
    Roberts TA, Auinger P, Ryan SA (2004) Body piercing and high-risk behavior in adolescents. J Adolesc Health 34:224–229CrossRefPubMedGoogle Scholar
  66. 66.
    Gold MA, Schorzman CM, Murray PJ et al (2005) Body piercing practices and attitudes among urban adolescents. J Adolesc Health 36(352):e17–e24Google Scholar
  67. 67.
    Venta I, Lakoma A, Haahtela S et al (2005) Oral piercings among first-year university students. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99:546–549CrossRefPubMedGoogle Scholar
  68. 68.
    Suris JC, Jeannin A, Chossis I et al (2007) Piercing among adolescents: body art as risk marker. J Fam Pract 56:126–130PubMedGoogle Scholar
  69. 69.
    Bone A, Ncube F, Nichols T et al (2008) Body piercing in England: a survey of piercing at sites other than earlobe. BMJ 336:1426–1428CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Skegg K, Nada-Raja S, Paul C et al (2007) Body piercing, personality, and sexual behavior. Arch Sex Behav 36:47–54CrossRefPubMedGoogle Scholar
  71. 71.
    Cegolon L, Mastrangelo G, Mazzoleni F, Majori S, Baldovin T, Xodo C, VAHP Working Group (2010) Body Art in 4277 Italian secondary school adolescents: prevalence and associations with personal and family characteristics. Fam Med 42(4):273–279PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of DermatologyFeinberg School of Medicine, Northwestern UniversityChicagoUSA
  2. 2.Department of Dermatology, Venereology and AllergologyUniversity of Helsinki and Helsinki University Central Hospital, Skin and Allergies HospitalHelsinkiFinland
  3. 3.Department of DermatologyBichat-Claude Bernard Hospital, Assistance Publique–Hôpitaux de ParisParisFrance

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