Treatment for Piercing Infections
The treatment for piercing infections includes cleaning with antimicrobial solutions, applying topical antimicrobials for localized infections, and using appropriate systemic antibiotics (particularly fluoroquinolones for cartilage infections) along with removal of the jewelry in severe cases.
Initial Assessment and Management
- Evaluate the type and location of the piercing infection, as different sites have varying complications and healing times 1
- For minor infections, cleanse the area with antimicrobial solutions such as chlorhexidine or betadine 1
- Apply a bland emollient (such as 50% white soft paraffin with 50% liquid paraffin) to support barrier function and encourage re-epithelialization 1
- For oral piercings, rinsing with nonprescription oral cleansers or application of cleansers like Listerine or Gly-Oxide is recommended to prevent infection 1
Antibiotic Therapy
- For auricular perichondritis (infection of ear cartilage), fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) are strongly recommended due to their activity against Pseudomonas aeruginosa 1, 2
- Alternative options for hospitalization may include clindamycin, ceftazidime, and cefepime depending on the pathogen 1
- For most piercing infections, antibiotic coverage should target both Gram-negative bacteria (especially Pseudomonas) and Staphylococcus aureus 3, 4
- A short-term course of antibiotic therapy (3-5 days) is typically sufficient for minor infections, but should be continued if signs of inflammation or infection persist 1
Specific Management by Piercing Site
Ear Piercings
- For auricular perichondritis (painful swelling, warmth, and redness that often spares the earlobe), prompt treatment with fluoroquinolones is essential 1, 5
- Acute tenderness on deflecting the auricular cartilage helps distinguish deeper perichondrial infection from superficial skin infection 1
- If an abscess is present, surgical incision and drainage are often necessary 1, 3
Oral Piercings
- Rinse with nonprescription oral cleansers or apply topical cleansers 1
- Monitor for signs of Ludwig angina (rapidly spreading oral cellulitis), which requires systemic antibiotics and possibly surgical drainage 1
Navel Piercings
- These often have prolonged healing times (up to 9 months) and higher infection rates due to friction from clothing 1, 2
- Keep the area clean and dry, and avoid tight clothing over the piercing site 1
Surgical Intervention
- If an abscess is present, surgical incision and drainage are necessary 1, 3
- For embedded jewelry, gentle probing may be attempted, but a small incision under local anesthesia may be necessary if unsuccessful 1
- In cases of severe infection with necrosis, debridement of necrotic cartilage may be required 5
Prevention of Complications
- Choose qualified practitioners for piercings to minimize risk of infection 1
- Observe proper hygiene practices, including the piercer using new disposable gloves and sterile equipment 1
- Avoid piercing cartilage with piercing guns, as this increases risk of infection and tissue damage 5
- Patients with a history of keloid formation should avoid body modifications that puncture the skin 1
- Those with congenital heart disease may need antibiotic prophylaxis before piercing 1