Ask Angel

Povidone-Iodine Skin Prep for Piercing

I did not get very good training in my apprenticeship and I am embarrassed to even ask this question, but I don’t know who else to turn to. What do you recommend for cleaning the area before piercing?

I have been using alcohol but heard that it may not be the best thing. Plus I know it is pretty uncomfortable on nose piercings. I have seen that some piercers use Iodine but I am kinda intimidated since I don’t know anything about it. I would really appreciate having your advice.

Thank you for writing articles in Pain Magazine, because I always learn something new.
I.


Dear I.,

Normal human skin contains resident and transient flora—microorganisms that can cause infection, so it is vital that these be removed or inactivated prior to piercing. Successful skin prep will quickly destroy or reduce these to sub-pathogenic (non-disease-causing) levels. I remain a fan of iodine-based solutions such as Betadine® to prepare the area before piercing. They are easy to use, safe, and effective for our purposes. However, other FDA-approved surgical skin preparations could suffice when used according to manufacturers’ instructions, providing they do not cause irritation or tissue damage.

Isopropyl alcohol is customarily used before injections, and in phlebotomy prior to venipuncture (drawing blood). But in the United States, alcohol-only prep is not a standard practice for body piercing. In the professional piercing world, we have a common and accepted two-step skin-prep process. First is swabbing with individually packaged, sterile 70% isopropyl alcohol pads to remove any make-up, skin oils, dirt, and debris. Following that is the actual cleansing with a surgical scrub product. The initial step is omitted when piercing mucous membranes (mucosa), including the interior of the nose and mouth, vulva, and penile glans. Alcohol is very harsh and unpleasant in these regions, and it can be harmful to the delicate tissues.

Note that skin preps with chlorhexidine gluconate (CHG)—another prevalent chemical used in the medical field—contain alcohol, and are generally not suited for use on the sensitive mucosa. CHG should also be avoided on ears due to risk of deafness if it enters the inner ear canal, and it can cause corneal damage should it get into the eye. Thus, though effective, formulations with this active ingredient have not gained popularity in the body piercing arena.

According to the Association of Professional Piercers (APP), chemical agents selected for skin preparation should have the following properties:

  • Broad-spectrum antimicrobial action
  • Rapid activation and prolonged effectiveness
  • Minimal irritation/sensitization potential
  • Quick and convenient application

 

Rich Hartwick, Iconic Tattoo & Piercing, Detroit, MI

Povidone-iodine (PVP-I, also called an iodophor) embodies these properties quite well, and is suitable for use on mucosa. Povidone is a synthetic polymer that helps to stabilize, suspend, and disperse iodine. Products are available with concentrations between 5 and 10% iodine, and their use for skin prep in the medical field is tremendously widespread.

Occasionally there are reports of skin irritation reactions, though sensitivity is usually to ingredients other than iodine. True iodine allergies are a myth(i), and contrary to popular lore, an allergy to seafood or shellfish does not increase the likelihood of a reaction to iodine(ii). Still, I always ask if clients have any history of sensitivity to iodine, and use an alternate scrub on the rare occasions in which they respond affirmatively. In my entire career, I have never witnessed a single negative reaction to PVP-I, and I’ve used a LOT of it over the decades.

Prep solutions sold in bulk packaging have potential for contamination with pathogens once opened(iii). Some have been marketed to the piercing industry, but sterile, single-use individual containers are the way to go, as per the FDA, AORN, and other medical organizations. For further reading on evaluating targeted products, I highly recommend Jef Saunders’ fabulous blog post: Why the Next Skin Prep Fad Will Hurt Body Piercing(iv).

Povidone-iodine is sold in individually packaged pads or swabsticks (and in double- or triple-swab packets). The pads tend to be comparatively dry, so I prefer the swabsticks, and their handles make them more hygienic than a hand-held wipe.

A prep’s effectiveness is impacted by the technique in which it is applied, in addition to its ingredients. Always follow manufacturers’ guidelines for usage. Iodophors typically require a minimum thirty-second contact time and a two-minute drying time. Concentric circular cleansing (moving outward from the center) was the standard method in nursing for years, but no scientific evidence to support this practice could be found in a 2009 medical literature review(v). Newer research shows that a back-and-forth scrub is being promoted.

Many spots we pierce including ears, noses, navels, and others, have uneven surfaces with small nooks and crannies, so either method can be difficult to replicate. To successfully achieve antisepsis of the skin, it is desirable to apply prep products to the area using ample friction, and to cover a region extending reasonably beyond the tissue being pierced. I find that swabsticks potentially have five different scrubbing surfaces: I routinely cleanse using each of four sides that can be produced by rotating the stick a quarter turn at a time, then finish with a swipe using the very tip.

A crucial aspect to using iodine is to allow it to dry completely before piercing. This is how the germicidal action happens. During the interval while the site fully dries, I take the time to connect with my client. I look them in the eye instead of remaining focused solely on the area in question. I love to chat, especially to discuss their motivations for getting pierced. I’ll explain the aftercare guidelines and answer any questions. I’ve realized that when I used wipe-on, wipe-off products with no drying time, my job satisfaction suffered because I lacked the opportunity/necessity to pause during the procedure and relate to each piercee.

Another benefit of iodine is that it clearly delineates the area that has been prepped due to the orange-brown coloration that temporarily stains the skin. On that note, be aware that it is important to remove iodine after the piercing is complete, as skin irritation could result from prolonged exposure. For this, I use individually packaged sterile saline pads. These clean off the iodine tinge, and any blood. Saline pads also have a wonderfully coolinsg effect that reduces the stinging or discomfort that can follow a piercing. Do not remove iodine before the piercing procedure, as it does not have residual antiseptic action.

Yet another advantage to using iodophors is that they leave the surface tacky as compared to soapier options. When lathering prep products are applied, the skin always remains more slippery, no matter how much wiping and drying takes place. Since I work exclusively with delicate nipple and genital tissues, excess rubbing is irritating and undesirable—as is a slippery piercing site.

Using povidone-iodine for skin prep gives me peace of mind based on medical research and extensive clinical practice. It is one of few such preparations that can be safely and comfortably applied on mucous membranes, which makes it especially well-suited to piercings.

References:

(i) “The relationship of radiocontrast, iodine, and seafood allergies: a medical myth exposed” https://www.ncbi.nlm.nih.gov/pubmed/20045605
(ii) “Shellfish-iodine nexus is a myth” https://www.mdedge.com/jfponline/article/63927/shellfish-iodine-nexus-myth
(iii) “Outbreaks Associated with Contaminated Antiseptics and Disinfectants” http://aac.asm.org/content/51/12/4217.full
(iv) http://www.jefsaunders.com/2011/05/why-next-skin-prep-fad-will-hurt-body_17.html
Owner of Gamma Piercing, Instructor at the Fakir Intensives, and current President of the Association of Professional Piercers. www.piercingnerd.com
(v) https://www.researchgate.net/publication/24213835_Going_Around_in_Circles_Is_This_the_Best_Practice_for_Preparing_the_Skin

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