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A survey conducted among college freshmen from Italy found that many students undergoing tattooing and/or piercing were unaware of the associated health risks.Although most (60%) students knew about HIV-related risks, less than half knew about possible infection with hepatitis C (38%), hepatitis B (34%), tetanus (34%), or about noninfectious complications (28%).Although body modifications have become a mainstream trend, they still may be associated with medical complications and, among adolescents, may also co-occur with high-risk behaviors.This first clinical report from the American Academy of Pediatrics on tattooing, piercing, and scarification discusses the history of these methods of body modification, educates the reader on methods used, reports on trends in associated adolescent and young adult risk behaviors, differentiates between nonsuicidal self-injury (NSSI) and body modifications, and educates the reader about how to anticipate and prevent potential medical complications.Although in the past, body modification was often associated with adolescent high-risk behaviors, current data have not consistently reported this association.

NSSI differs from body modification because NSSI often is impulsive or compulsive and may be associated with mental health disorders, including psychotic disorders, personality disorders, and anxiety disorders.

Individuals who hurt themselves report injuries to many different body parts.

Importantly, NSSI is clinically concerning because of an association with mental health disorders, whereas body modification such as tattooing, piercing, and/or scarification does not have these associations and is more socially acceptable.

Scarification is the practice of intentionally irritating the skin to cause a permanent pattern of scar tissue.

Studies have been conducted among international communities describing high rates of scarification, yet no studies on scarification have been reported from the United States.

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