Teens' skin: tanning, tattooing & body piercing.

What is it about skin and teenage girls? If they're not piercing and tattooing it, they're burning it in the sun or browning it in tanning beds. "I'd love to get my belly button pierced," says Britney **, 13. "I want to pierce my belly button and I want about four tattoos," says Mimi **, 12.

"I'm definitely seeing more and more body art," says Donnese Kern, RN-CS, MSN, NCSN, NP, coordinator of school health services for the Big Stone Gap, VA, school district and a school nurse for more than 32 years. "Kids have always done crazy things to be able to say 'this is me,' but I don't believe they fully understand the permanence of body art."

It could also be a warning sign that a girl is engaging in, or is vulnerable to, risky behavior. Studies of more than 6,000 junior and high school students found that those with tattoos and body piercings were more likely to smoke cigarettes or marijuana, go on drinking binges, have premarital sex, get into serious fights, join gangs, skip school and get poor grades. (16,17) "If a child asks for a tattoo, the parent should recognize that as an opportunity to talk," says Timothy Roberts, MD, an adolescent medicine specialist at the University of Rochester's Children's Hospital at Strong, who co-authored two such studies. (16)

Even girls who wouldn't dream of scarring their body with a tattoo, however, think nothing of scarring it with a sunburn. Pammy*, 13, admits to tanning "without meaning to, when I'm walking or swimming." Yet she only uses sunscreen when she's in Florida or when "it's really, really sunny and hot."

Pammy is typical. Just four in 10 adolescent girls wear sunscreen, (18) while about a third say they limit their sun exposure. (19) This, despite the fact that high school students regularly get enough ultraviolet exposure during their daily activities to potentially burn them if they're fair-skinned. (20) Or that almost 80 percent of a person's lifetime sun exposure occurs before age 18. Or that most skin cancers are caused by unprotected sun exposure in childhood and adolescence. (21) One large national study of adolescents age 12 to 18 even found that half of those who got sunburned more than once agreed it was worth it to get a tan later on. (18)

Teens also don't seem to understand that tanning booths and beds are just as, if not more, dangerous than the sun. Just 15 to 30 minutes in a tanning salon is the equivalent of an entire day at the beach. Additionally, tanning beds, booths and sunlamps radiate both UVB rays and long wave UVA rays that penetrate the skin more deeply than sunlight, making it even more vulnerable to the effects of the sun and making both melanoma and non-melanoma skin cancers more likely. (22) Yet nearly one in four teenage girls 15 and older use tanning beds. (18)

"It's really hard to get their attention," says Sandra Read, MD, a dermatologist in Washington, DC, and clinical instructor at Georgetown University, of teens' desire for a dark tan. And you certainly can't immobilize a 16-year-old between your knees and smother her with sunscreen as you can a six-year-old. One thing that might help, she suggests, is to share with them the cosmetic repercussions of too much sun, including premature wrinkling, discolorations and fine lines or show them photographs of people with skin cancer.

But even these approaches might not work. "I use sunscreen when 1 lie in the sun for a long time," says Mimi, but not if she's only going to be out for a short while. And yes, she says, "I understand the health risks."

** Not their real names

(16.) Tattoos mark youths prone to high-risk behavior. University of Rochester Medical Center (press release] April 27, 2001.

(17.) Carroll ST, Riffenburgh RH, Roberts TA, Myhre EB. Tattoos and body piercings as indicators of adolescent risk-taking behaviors. Pediatrics. 2002 Jun;109(6):1021-10217.

(18.) Geller AC, Colditz G, Oliveria S, Emmons K, Jorgensen C, Aweh GN, Frazier AL. Use of sunscreen, sunburning rates, and tanning bed use among more than 10,000 US children and adolescents. Pediatrics. 2002 Jun;109(6):1009-14.

(19.) Healthy People 2010, www.health.gov

(20.) New Study Finds High School Students Get Enough UV Exposure on an Average Day to Cause Sunburn, American Academy of Dermatology, [press release], April 24, 2002, www.aad.org

(21.) Keeping Skin Safe and Healthy, American Academy of Pediatrics, [press release], 2002, www.aap.org

(22.) Indoor Tanning: All the Dangers of the Outdoor Sun, Including Skin Cancer, American Academy of Dermatology, [press release], April 24, 2002 www.aad.org

(23.) Oral piercing, frequently asked questions, American Dental Association, www.ada.org

(24.) Rash decision, New Scientist [press release], Aug. 15, 2001.

RELATED ARTICLE: Tattoos and Body Piercing Health Risks

Trendy as it may be, many teens overlook the health risks associated with body art, medical experts say. Health risks associated with piercings, for example, include infections, scar tissue and draining wounds. Tongue piercing involves such risks as uncontrollable bleeding or nerve damage, swelling that closes off the airway, choking on jewelry that comes loose or chipped or cracked teeth. (23) Tattooing can cause allergic reactions or spread diseases such as hepatitis and AIDS. Even temporary henna tattoos can result in months of pain and discomfort, and a lifelong allergy to a common chemical found in the dyes, according to a German study. (24)