What to do for a 13-year-old with an infected nose piercing?

Management of Infected Nose Piercing in a 13-Year-Old

For a 13-year-old with an infected nose piercing, prompt treatment with a combination of gentle cleaning with saline solution 2-3 times daily, application of topical antibiotics, and removal of the jewelry is recommended to prevent complications such as perichondritis or abscess formation.

Initial Assessment

When evaluating an infected nose piercing, look for:

• Signs of local infection: redness, swelling, warmth, pain, purulent discharge
• Signs of spreading infection: increasing redness, streaking, fever
• Location of the piercing (cartilage vs. soft tissue of the nostril)
• Duration of symptoms and piercing history

Treatment Algorithm

Step 1: Determine Severity of Infection

• Mild infection (localized redness, minimal discharge, no fever)
• Moderate infection (increased pain, purulent discharge, surrounding cellulitis)
• Severe infection (spreading cellulitis, fever, systemic symptoms, abscess formation)

Step 2: Management Based on Severity

For Mild to Moderate Infection:

1. Remove the jewelry to facilitate drainage and prevent embedding 1
2. Clean the area 2-3 times daily:
   • Use warm saline solution (1/4 teaspoon salt in 8 oz water)
   • Gently remove crusts and discharge
3. Apply topical antibiotic such as bacitracin 1-3 times daily 2
4. Monitor for 48-72 hours for improvement

For Moderate to Severe Infection:

1. Remove the jewelry immediately 1
2. Start oral antibiotics to cover common pathogens (Staphylococcus aureus, Streptococcus, Pseudomonas) 1, 3, 4:
   • For children ≥13 years: Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days 5
   • For penicillin allergy: Clindamycin 300-450 mg three times daily for 5-7 days 5
3. Consider incision and drainage if abscess is present 5
4. Seek immediate medical attention if symptoms worsen or include:
   • High fever (≥39°C/102.2°F)
   • Significant swelling that could compromise breathing
   • Spreading redness beyond the immediate area
   • Formation of an abscess

Special Considerations

Nasal Cartilage Involvement

If the piercing involves the cartilage (septum or upper nostril), there's a higher risk of perichondritis, which can lead to cartilage necrosis and permanent deformity 1, 6. These infections require:

• More aggressive treatment with fluoroquinolone antibiotics (for patients >18 years) 1
• Lower threshold for specialist referral (ENT)

Prevention of Recurrence

After the infection resolves:

• Wait at least 6-8 weeks before considering re-piercing 1
• Choose a professional piercer who uses sterile techniques 7
• Select appropriate jewelry material (surgical stainless steel, titanium) to reduce allergic reactions 1

Common Pitfalls to Avoid

1. Delay in removing jewelry: Keeping jewelry in place can impede drainage and worsen infection 1
2. Inadequate cleaning: Insufficient removal of discharge can harbor bacteria 1
3. Inappropriate antibiotic selection: Not covering Pseudomonas when cartilage is involved 1, 6
4. Missing systemic infection: Failing to recognize signs of spreading infection requiring oral antibiotics 5
5. Premature re-piercing: Not allowing complete healing before re-piercing 1

Nose piercings typically take 6-8 weeks to heal completely 1, and proper aftercare is essential to prevent complications. Parents should be educated about the risks of body piercing in adolescents and the importance of seeking professional piercing services that follow proper sterilization procedures 8.