What is the treatment for an ear piercing infection?

Treatment for Ear Piercing Infections

For ear piercing infections, the treatment includes removing the earring, cleaning the area, applying topical antibiotics, and in severe cases, using oral antibiotics that cover common pathogens like Pseudomonas aeruginosa and Staphylococcus aureus. 1

Types of Ear Piercing Infections

• Minor infections (most common - 77% of complications) present with redness, swelling, pain, and possibly discharge from the piercing site 1
• Auricular perichondritis involves infection of the cartilage, presenting with painful swelling, warmth, and redness that often spares the earlobe, typically occurring within the first month after piercing 1
• Perichondrial abscess is a more serious complication that can lead to cartilage necrosis and permanent deformity if not treated promptly 1, 2

Treatment Algorithm

For Minor Infections (Earlobe or Superficial):

1. Remove the earring to allow for proper drainage and healing 1
2. Clean the area thoroughly with mild soap and water or saline solution 1
3. Apply topical antibiotic such as bacitracin 1-3 times daily 3
4. Monitor for 48-72 hours for improvement 1
5. If improving, continue treatment until resolution (typically 7-10 days) 1

For Auricular Perichondritis (Cartilage Infection):

1. Remove the earring immediately 1
2. Start fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) which are effective against the most common pathogens (Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pyogenes) 1, 4
3. Alternative antibiotics may include clindamycin, ceftazidime, or cefepime depending on the suspected pathogen 1
4. Duration of treatment is typically 10-14 days, but may extend to 2-4 weeks for severe cases 1, 2
5. Consider hospitalization for severe infections, especially in cases with systemic symptoms 1, 2

For Perichondrial Abscess:

1. Surgical incision and drainage is often necessary 1
2. Intravenous antibiotics covering Pseudomonas and Staphylococcus 1, 2
3. Dual antibiotic therapy may be required initially (median duration 6 days), followed by oral antibiotics (median duration 15 days) 2
4. Close follow-up is essential as cosmetic preservation of auricular cartilage becomes difficult once an abscess develops 1

Special Considerations

• Distinguish superficial infection from perichondritis: Acute tenderness on deflecting the auricular cartilage helps distinguish deeper perichondrial infection from a superficial skin infection 1
• Cartilage piercings have higher risk of serious infection than earlobe piercings 4, 5
• Contact dermatitis may mimic infection and is common with nickel exposure; treatment involves removing the earring and applying topical corticosteroids 1
• Re-piercing should only be done 6-8 weeks after complete resolution of infection and in an unscarred area 1
• Embedded earrings may require surgical removal under local anesthesia if gentle probing fails 1

Prevention of Complications

• Choose experienced practitioners using proper sterilization techniques 1, 6
• Avoid piercing guns for cartilage piercings, as they have been associated with outbreaks of Pseudomonas infections 5
• Use appropriate jewelry materials to avoid allergic reactions 1
• Proper aftercare including regular cleaning and avoiding trauma to the site 6
• Remove jewelry at bedtime to prevent pressure sores or irritation 1

Common Pitfalls to Avoid

• Delayed treatment of cartilage infections can lead to permanent deformity 1, 2
• Using inappropriate antibiotics: Many patients are initially treated with antibiotics ineffective against Pseudomonas, which is a common pathogen in cartilage infections 5
• Failure to remove the earring in case of infection can impede drainage and prolong healing 1
• Inadequate follow-up: Infections can progress rapidly, especially in cartilage piercings 1, 2
• Re-piercing too soon before complete healing can lead to recurrent infections or scarring 1