Piercing Earlobe Again After Rejection if Piercing Failed Once How Likely It Will Fail Again
Complications of Body Piercing
Am Fam Doc. 2005 November 15;72(10):2029-2034.
Patient information: Meet related handout on body piercing, written by the author of this commodity.
Commodity Sections
- Abstract
- Body Piercing Jewelry
- Oral Piercings
- Ear Piercings
- Nose Piercing
- Navel Piercing
- Nipple Piercing
- Genital Piercings
- Systemic Infectious Complications
- References
The trend of body piercing at sites other than the earlobe has grown in popularity in the past decade. The natural language, lips, nose, eyebrows, nipples, navel, and genitals may be pierced. Complications of body piercing include local and systemic infections, poor cosmesis, and foreign body rejection. Swelling and molar fracture are common issues later on tongue piercing. Minor infections, allergic contact dermatitis, keloid formation, and traumatic fierce may occur after piercing of the earlobe. "Loftier" ear piercing through the ear cartilage is associated with more serious infections and disfigurement. Fluoroquinolone antibiotics are advised for treatment of auricular perichondritis because of their antipseudomonal activity. Many complications from piercing are torso-site–specific or related to the piercing technique used. Omphalos, nipple, and genital piercings often have prolonged healing times. Family physicians should be prepared to accost complications of body piercing and provide accurate information to patients.
SORT: Central RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | References |
|---|---|---|
| Persons contemplating natural language piercing should exist advised of the loftier incidence of tooth chipping associated with such piercings. | C | 2 |
| Rinsing with nonprescription oral cleansers (due east.g., Listerine) or topical application of cleansers (e.g., Gly-Oxide) is recommended to prevent infection after oral piercing. | C | 17 |
| Antibiotics with good coverage confronting Pseudomonas and Staphylococcus species (eastward.g., fluoroquinolones) should be used when treating piercing-associated infections of the auricular cartilage. | C | 7, 18, xix |
| Earrings with locking or spiral-on backs are recommended for infants and young children considering of the risk of ingestion or aspiration. | C | 29 |
In recent years, trunk piercing has increased in popularity and social acceptance. Piercing of diverse body parts with jewelry is no longer express to teenagers, equally evidenced by the growing number of adults with multiple ear piercings. Family physicians should be familiar with body piercing practices and associated wellness risks (Table 11–14). No reliable estimates are available for the number of persons who accept experienced complications related to body piercing. Persons with increased vulnerability to infection (east.g., patients with diabetes, patients taking corticosteroids) and those who have an increased likelihood of hemorrhage (eastward.g., persons taking anticoagulant medication) may be at greater adventure of complications from torso piercing.
Table one
Potential Complications of Body Piercings
| Piercing site | Potential complications |
|---|---|
| Ear | Allergic reaction, auricular perichondritis, embedded earrings, infection, keloid formation, perichondral abscess, traumatic tear |
| Genitals (women) | Allergic reaction, compromise of barrier contraceptives, infection, keloid formation |
| Genitals (men) | Frictional irritation, infection, paraphimosis, penile engorgement, priapism, recurrent condyloma, urethral rupture, urethral stricture, urinary catamenia intermission |
| Mouth | Airway compromise, contradistinct eating habits, gingival trauma, hematoma formation, increased salivary catamenia, infection, injury to salivary glands, interference with radiographs, loss of gustation, Ludwig'due south angina, pain, permanent numbness, speech impediments, tooth fracture or chipping, uncontrolled drooling |
| Navel | Bacterial endocarditis,* frictional irritation, infection, jewelry migration and rejection |
| Nipples | Abscess formation, bacterial endocarditis,* breastfeeding impairment, infection |
| Nose | Infection, jewelry swallowing or aspiration, perichondritis and necrosis of nasal wall, septal hematoma germination |
Body Piercing Jewelry
- Abstract
- Body Piercing Jewelry
- Oral Piercings
- Ear Piercings
- Olfactory organ Piercing
- Belly button Piercing
- Nipple Piercing
- Genital Piercings
- Systemic Infectious Complications
- References
Most body piercing jewelry consists of rings, hoops, studs, or barbell-shaped ornaments. The size and shape of jewelry is determined past the body site pierced and personal preferences. Jewelry is not always interchangeable between piercing sites. In item, jewelry designed for ear piercing may not be suitable for another part of the torso because of the length of the post or the pressure exerted past the squeeze.
Virtually body piercing jewelry is fabricated of metal, usually stainless steel, gold, niobium, titanium, or alloys. Surgical stainless steel rarely causes allergic peel reactions; however, non all stainless steel products are nickel-gratis.15 Aureate often is combined with nickel or other metals to brand alloys that have improved hardness and durability. Nickel in gold-filled or gilt-plated jewelry is associated with a high prevalence of reactivity in persons who are nickel sensitive. Consumers must pay conscientious attending to the stud or clasp on earrings; jewelry with a high karat rating commonly is paired with less expensive gold-plated studs or earring backs. Niobium and titanium are calorie-free-weight elemental metals that rarely produce an allergic response. Other features to consider in trunk piercing jewelry include ease of removal (in example of trauma or radiographs), surface smoothness, and its capacity to with-stand autoclaving and cleaning.
Oral Piercings
- Abstruse
- Body Piercing Jewelry
- Oral Piercings
- Ear Piercings
- Nose Piercing
- Omphalus Piercing
- Nipple Piercing
- Genital Piercings
- Systemic Infectious Complications
- References
The lips, cheeks, and midline of the tongue are pop sites for oral piercings. Perforation of lingual blood vessels tin can cause bleeding and hematoma formation. Edema frequently develops afterward tongue piercing, so a longer barbell is recommended initially.16
Some other serious issue of oral piercing is compromise of the airway from trauma, natural language swelling, or obstruction by jewelry.1 Securing an adequate airway or endotracheal intubation can be challenging when a patient has a tongue barbell. If lingual jewelry cannot exist removed easily or expeditiously, precautions should be taken during intubation to ensure that jewelry is not loosened and aspirated or swallowed. Removal of oral and nasal jewelry also is recommended before nonemergent surgical procedures.
DENTAL COMPLICATIONS
Chipping (or fracture) of teeth is the most common dental problem related to tongue barbells ( Figure ane ).2 Switching to a shorter barbell reduces damage to the dentition and gingiva. Beaded jewelry may become trapped between teeth.
Tongue barbell with an acrylic ball.
Effigy 1
Although there is a take chances of infection considering of the vast amounts of bacteria in the mouth, the infection rate actually is low. Oral rinses (e.g., Listerine) or application of nonprescription cleansers (e.grand., Gly-Oxide) may be recommended prophylactically after oral piercing.17 Ludwig's angina is rare, simply this rapidly spreading oral cellulitis has been reported as a complexity of natural language piercing.5 Treatment involves maintaining an adequate airway, administration of systemic antibiotics, and surgical drainage of abscesses.
Ear Piercings
- Abstruse
- Trunk Piercing Jewelry
- Oral Piercings
- Ear Piercings
- Nose Piercing
- Navel Piercing
- Nipple Piercing
- Genital Piercings
- Systemic Infectious Complications
- References
INFECTIOUS COMPLICATIONS
The ear is the most common site for body piercing. In one study,half-dozen upward to 35 percent of persons with pierced ears had one or more than complications (eastward.thou., minor infection [77 pct], allergic reaction [43 percent], keloid formation [2.5 pct], and traumatic vehement [2.5 percentage]).
Multiple ear piercings take gained popularity, especially "high" piercing through the cartilage of the pinna ( Figure 2 ). These piercings are associated with poor healing and more than serious infection because of the avascular nature of auricular cartilage. Auricular perichondritis and perichondrial abscess typically occur in the get-go month after piercing, especially during warm-weather months.seven Auricular perichondritis presents every bit painful swelling, warmth, and redness in a portion of the auricle that often spares the earlobe. Acute tenderness on deflecting the auricular cartilage helps distinguish this deeper perichondrial infection from a superficial skin infection. Small-scale infections can progress to perichondritis, abscess formation, and necrosis with or without systemic symptoms. The nearly mutual pathogens (i.e., Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pyogenes) respond well to fluoroquinolone antibiotic treatment (eastward.thou., ciprofloxacin [Cipro]).18,19 If an abscess is nowadays, surgical incision and drainage often are necessary. In one case an abscess develops, good corrective preservation of the auricular cartilage is difficult to maintain.
"Loftier" ear piercing through the cartilage.
Effigy 2
Persons with atopic dermatitis or allergic metal contact dermatitis are at increased risk for developing pocket-size staphylococcal or streptococcal skin infections.twenty A localized infection of the earlobe may non exist easily differentiated from allergic contact dermatitis unless at that place is purulent drainage or a high index of suspicion.21 Superficial earlobe infections tend to have a benign form and reply well to local treatment, including warm, moist packs and application of over-the-counter topical antibiotic ointment. Treatment with 2 percent mupirocin ointment (Bactroban) or oral antistaphylococcal antibiotics may be warranted.
NONINFECTIOUS COMPLICATIONS
The earlobe is a common site for hypertrophic scarring and keloid formation. In add-on to aesthetic concerns, patients with keloids may accept itching and tenderness. Treatment options for keloids include surgical excision, intralesional corticosteroid injections, cryosurgery, pressure dressing, radiation, and light amplification by stimulated emission of radiation therapy.22,23
Contact dermatitis resulting from nickel exposure is common. Contact sensitivity to gilded and localized argyria, a pare discoloration resulting from argent salts, also have been described.21,24 Abstention of the metals that trigger a reaction and application of topical corticosteroids hasten the resolution of allergic dermatitis.
Occasionally, inflammation or infection results in such significant swelling that an earring must be removed. The pierced hole can be maintained past inserting a ring made from a 20-gauge Teflon catheter with silicone tubing into the hole while the surrounding skin heals.25 Similarly, a loop fashioned from nylon suture fabric may keep a piercing intact during the healing procedure.
Earrings can get embedded in the earlobe, a complication common in persons with thick, fleshy earlobes that are pierced with spring-loaded guns.26 Piercing guns exert high pressure on the soft tissue of the earlobe and cannot be adjusted for varying tissue thickness. Embedding may be prevented past using longer earring posts with adjustable backings.
If gentle probing fails to locate an embedded ear-ring, a small incision under local anesthesia (without epinephrine) may exist necessary to locate and remove the earring or bankroll. Any suspected infection should be treated. Over-the-counter topical antimicrobials (e.g., bacitracin, Polysporin, Neosporin) are indicated for handling of superficial skin infections. Oral antibiotics such every bit the first-generation cephalosporins (east.g., cephalexin [Keflex], cefadroxil [Duricef]) and penicillinase-resistant penicillins (eastward.k., dicloxacillin [Dynapen]) are appropriate handling options for more serious wound infections. An earring tin exist replaced or the ear repierced six to viii weeks later resolution of local swelling and tenderness.21
Trauma to the pierced external ear is common. Lacerations to the ear may occur later falls, motor vehicle crashes, contact sports, person-to-person violence, or accidental pulling of an earring. The simplest laceration occurs when an earring is pulled through the earlobe, especially if the original earring hole was close to the periphery ( Figure 3 ) . Prolonged wearing of heavy jewelry also may result in an elongated tract or bifid deformity of the earlobe.
Traumatic tear of the earlobe.
Figure 3
All wounds should be cleaned and repaired within 12 to 24 hours. A unproblematic ear lobe tear tin be sutured under local anesthesia. If the pigsty has closed, the ear lobe can be repierced in a nonscarred area subsequently approximately three months.27 Various closure techniques have been described in the literature28 for more complex lacerations of ear cartilage. Many family unit physicians refer these complicated injuries to subspecialists for repair.
Pointed earring posts may cause pressure level sores or postauricular skin irritation when worn during slumber. Removal of jewelry at bedtime is indicated if switching to a different ear-ring manner does non resolve the problem. Parents of infants or young children with pierced ears should be informed of the risk of aspiration and ingestion of earring parts. In such situations, earrings with a locking back or screw back are advisable.29
Family physicians play an important part in promoting injury prevention by recommending that all jewelry exist removed during contact sports to avert endangering the wearer and other players. If body jewelry remains comfortable and does not produce frictional irritation, athletes should exist able to keep the jewelry in place during noncontact personal workouts.30 Jewelry that interferes with mouthguards or protective equipment should be removed before play.
Nose Piercing
- Abstract
- Body Piercing Jewelry
- Oral Piercings
- Ear Piercings
- Nose Piercing
- Omphalus Piercing
- Nipple Piercing
- Genital Piercings
- Systemic Infectious Complications
- References
The nose tin be pierced in the fleshy nares or through the cartilaginous septum. Septal piercings usually are performed in the junior fleshy role of the septum and not through cartilaginous tissue. Piercing the cartilage can cause significant bleeding and lead to septal hematoma formation that often is accompanied by infection. Other potential complications that may result in corrective deformity include perichondritis and necrosis of the cartilaginous nasal wall. Infection requires ambitious handling with antibiotics that have proficient coverage against Staphylococcus species that commonly colonize the nasal mucosa. Mupirocin is effective and offers fantabulous coverage against gram-positive cocci. Fluoroquinolones take the advantage of excellent skin penetration and added coverage confronting Pseudomonas species.
Nasal jewelry has the potential to be aspirated or swallowed. Rings placed in the nostril or septum also can migrate forward or exist pulled out. Equally with ear piercing, the studs or backings of the jewelry may become embedded and require surgical removal.31
Navel Piercing
- Abstract
- Body Piercing Jewelry
- Oral Piercings
- Ear Piercings
- Nose Piercing
- Umbilicus Piercing
- Nipple Piercing
- Genital Piercings
- Systemic Infectious Complications
- References
The navel or periumbilical area is a pop self-piercing site. Friction from clothing with tight-plumbing fixtures waist-bands and subsequent peel maceration may account for the delayed healing and increased infection rates of umbilicus piercings (Table iieight,nine). Careful placement of jewelry and avoidance of rigidly stock-still jewelry may minimize these problems.
Tabular array 2
Approximate Healing Times for Body Piercing Sites
| Site (piercing name) | Time to heal |
|---|---|
| Clitoris | two to 6 weeks |
| Coronal ridge (dydoe) | six to viii weeks |
| Ear lobe and auricle | 6 to eight weeks |
| Eyebrow | half dozen to eight weeks |
| Glans penis (ampallang) | 3 to 9 months |
| Labia majora | 2 to 4 months |
| Labia minora | 2 to vi weeks |
| Lip | 6 to eight weeks |
| Navel | Up to 9 months |
| Nipple | ii to 4 months |
| Scrotum (hafada) | 2 to 3 months |
| Tongue | 3 to 6 weeks |
| Urethral meatus (Prince Albert) | ii to 4 weeks |
Superficial navel piercings often tend to migrate to the pare surface. The problem of jewelry migration and rejection is compounded past wearing heavily weighted, thin-gauge jewelry. Migration of navel rings and subsequent scarring are more problematic in overweight patients and in the latter stages of pregnancy equally abdominal girth expands ( Figure four ) . Wearing a curved barbell instead of a ring until the navel piercing has healed may reduce irritation and scarring.
Hypertrophic scarring that adult afterward a omphalus ring began to migrate to the skin'southward surface during the third trimester of pregnancy.
Figure 4
Nipple Piercing
- Abstract
- Body Piercing Jewelry
- Oral Piercings
- Ear Piercings
- Nose Piercing
- Omphalos Piercing
- Nipple Piercing
- Genital Piercings
- Systemic Infectious Complications
- References
Before nipple and areolae piercings, men and women should be counseled nigh the lengthy time required for consummate healing and the risk of delayed infection. Abscess formation has been reported post-obit nipple piercing.x Except for example reports of cellulitis and spread of infection around an implant,32,33 little information is available about nipple piercing after breast implantation or chest wall augmentation. The effects of nipple piercings on lactation are not clear, but jewelry or scar tissue could impair latching on or cake a milk duct and adversely impact an infant's power to breastfeed.
Genital Piercings
- Abstract
- Body Piercing Jewelry
- Oral Piercings
- Ear Piercings
- Nose Piercing
- Belly button Piercing
- Nipple Piercing
- Genital Piercings
- Systemic Infectious Complications
- References
Genital piercings reportedly enhance sexual sensitivity. Piercing sites in men include the penile glans and urethra, foreskin, and scrotum; sites in women include the clitoral prepuce or torso, labia minora, labia majora, and perineum.34
PIERCINGS IN MEN
Jewelry inserted through the glans penis frequently interrupts urinary flow. Paraphimosis (i.e., the inability to supervene upon a retracted foreskin) has been associated with urethral and glans piercings in uncircumcised men.11 The foreskin may be reduced manually after a penile nerve cake. If this maneuver is unsuccessful, the prepuce can be injected with hyaluronidase (Vitrase) to allow the edematous fluid to dissipate.35 Penile rings too tin can cause engorgement and priapism (i.east., persistent erection), requiring emergency handling to preserve erectile office.
PIERCINGS IN WOMEN
Women with genital piercings tin develop haemorrhage, infections, allergic reactions, keloids, and scarring.12 Sexually active persons with genital piercings should be counseled that jewelry may compromise the use of barrier contraceptive methods. Condoms may be more prone to break and diaphragms may be more easily dislodged during sexual activity when one or both partners have genital piercings. Avoiding jewelry with sharp edges and using looser-plumbing equipment condoms or double condoms may assistance avoid some of these problems.36
Systemic Infectious Complications
- Abstruse
- Body Piercing Jewelry
- Oral Piercings
- Ear Piercings
- Nose Piercing
- Navel Piercing
- Nipple Piercing
- Genital Piercings
- Systemic Infectious Complications
- References
The American Heart Association guidelines on endocarditis prophylaxis37 practise not specifically address the need for antibiotics in persons contemplating ear or body piercings. One modest study38 of children and adults with congenital centre disease institute no cases of endocarditis after ear piercing, fifty-fifty though only 6 percent of patients received prophylactic antibody treatment. Recent reports13,14 of bacterial endocarditis after nipple and navel piercings in patients with surgically corrected built heart illness should prompt physicians to consider antibody prophylaxis in patients with moderate- or high-take chances cardiac conditions.
With any piercing, there is the danger of infection, including hepatitis B or C virus and tetanus.eight Trunk piercing as a possible vector for human immunodeficiency virus manual has been suggested.39 Nonsterile piercing techniques and poor hygiene contribute significantly to the increased hazard of infection. Although earrings may exist sterilized before use, most piercing "guns" are not sterilized between procedures. Ear piercing systems using dispensable sterile cassettes are available.
Family unit physicians should aid patients make informed decisions about body piercings and counsel them about the importance of universal precautions. Physicians should remain nonjudgmental so that patients are non reluctant to report a problem. Because trunk piercing salons are unregulated in many states, some physicians may cull to perform torso piercing procedures in the office setting.
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REFERENCES
prove all references
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three. Hardee PS, Mallya LR, Hutchison IL. Tongue piercing resulting in hypotensive collapse. Br Paring J. 2000;188:657-8.
4. Keogh IJ, O'Leary Thousand. Serious complication of tongue piercing. J Laryngol Otol. 2001;115:233-iv.
5. Perkins CS, Meisner J, Harrison JM. A complication of tongue piercing. Br Dent J. 1997;182:147-8.
6. Simplot TC, Hoffman HT. Comparison betwixt cartilage and soft tissue ear piercing complications. Am J Otolaryngol. 1998;nineteen:305-x.
7. Staley R, Fitzgibbon JJ, Anderson C. Auricular infections caused by high ear piercing in adolescents. Pediatrics. 1997;99:610-one.
viii. Tweeten SS, Rickman LS. Infectious complications of body piercing. Clin Infect Dis. 1998;26:735-40.
9. Anderson WR, Summerton DJ, Sharma DM, Holmes SA. The urologist'southward guide to genital piercing. BJU Int. 2003;91:245-51.
10. Trupiano JK, Sebek BA, Goldfarb J, Levy LR, Hall GS, Procop GW. Mastitis due to Mycobacterium abscessus later on body piercing. Clin Infect Dis. 2001;33:131-4.
xi. Hansen RB, Olsen LH, Langkilde NC. Piercing of the glans penis. Scand J Urol Nephrol. 1998;32:219-20.
12. Miller L, Edenholm M. Genital piercing to enhance sexual satisfaction. Obstet Gynecol. 1999;93:(five pt ii)837-
13. Ochsenfahrt C, Friedl R, Hannekum A, Schumacher BA. Endocarditis after nipple piercing in a patient with a bicuspid aortic valve. Ann Thorac Surg. 2001;71:1365-6.
14. Weinberg JB, Blackwood RA. Case study of Staphylococcus aureus endocarditis subsequently omphalus piercing. Pediatr Infect Dis J. 2003;22:94-6.
15. Gawkrodger DJ. Nickel dermatitis: how much nickel is prophylactic? Contact Dermatitis. 1996;35:267-71.
16. Reichl RB, Dailey JC. Intraoral trunk-piercing: a case study. Gen Paring. 1996;44:346-7.
17. Maibaum WW, Margherita VA. Tongue piercing: a concern for the dentist. Gen Dent. 1997;45:495-7.
18. Folz BJ, Lippert BM, Kuelkens C, Werner JA. Hazards of piercing and facial body art: a report of three patients and literature review. Ann Plast Surg. 2000;45:374-81.
19. More DR, Seidel JS, Bryan PA. Ear-piercing techniques as a cause of auricular chondritis. Pediatr Emerg Intendance. 1999;fifteen:189-92.
20. George J, White One thousand. Infection as a effect of ear piercing. Practitioner. 1989;233:404-6.
21. Hendricks WM. Complications of ear piercing: handling and prevention. Cutis. 1991;48:386-94.
22. Shaffer JJ, Taylor SC, Melt-Bolden F. Keloidal scars: a review with a critical look at therapeutic options. J Am Acad Dermatol. 2002;46:(2 suppl Understanding)S63-97.
23. Akoz T, Gideroglu M, Akan M. Combination of different techniques for the treatment of earlobe keloids. Artful Plast Surg. 2002;26:184-8.
24. Sugden P, Azad S, Erdmann M. Argyria caused by an earring. Br J Plast Surg. 2001;54:252-3.
25. Nakamura One thousand, Uchinuma Due east, Itoh Thousand, Shioya N. Device that keeps a pierced ear hole intact while treating an infected earlobe. Aesthetic Plast Surg. 1996;20:343-5.
26. Muntz Hour, Pa-C DJ, Asher BF. Embedded earrings: a complication of the ear-piercing gun. Int J Pediatr Otorhinolaryngol. 1990;19:73-six.
27. Watson D. Torn earlobe repair. Otolaryngol Clin North Am 2002;35:187–205,vii–viii.
28. Park SS, Hood RJ. Auricular reconstruction. Otolaryngol Clin Due north Am 2001;34:713–38,five–half dozen.
29. Becker PG, Turow J. Earring aspiration and other jewelry hazards. Pediatrics. 1986;78:494-half dozen.
xxx. Schnirring L. Body piercing and sports: an opening for trouble? Phys Sportsmed. 1999;27:27-33.
31. Watson MG, Campbell JB, Pahor AL. Complications of olfactory organ piercing. Br Med J (Clin Res ed). 1987;294:1262-
32. Javaid Thou, Shibu 1000. Breast implant infection following nipple piercing. Br J Plast Surg. 1999;52:676-7.
33. de Kleer N, Cohen M, Semple J, Simor A, Antonyshyn O. Nipple piercing may exist contraindicated in male person patients with chest implants. Ann Plast Surg. 2001;47:188-90.
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38. Cetta F, Graham LC, Lichtenberg RC, Warnes CA. Piercing and tattooing in patients with congenital centre disease: patient and physician perspectives. J Adolesc Health. 1999;24:160-2.
39. Pugatch D, Mileno Yard, Rich JD. Possible transmission of human being immunodeficiency virus blazon i from body piercing. Clin Infect Dis. 1998;26:767-8.
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