Should I remove an earring from an infected earlobe?

Management of an Infected Earlobe Piercing

Yes, you should remove the earring from an infected earlobe to allow proper drainage and facilitate healing. 1

Assessment of Infection

• Earlobe infections typically present with painful swelling, warmth, and redness, and are most common in the first month after piercing 1
• Distinguish between superficial skin infection (affecting only the earlobe) versus deeper perichondrial infection (which affects cartilage and often spares the earlobe) 1
• The most common pathogens involved in earlobe infections include Staphylococcus aureus and Streptococcus pyogenes 1, 2

Treatment Algorithm

Step 1: Remove the Earring

• Remove the earring to allow proper drainage and facilitate healing of the infection 1
• If the earring is embedded or difficult to remove:
  • Consider using a local anesthetic block of the greater auricular and auriculotemporal nerves to facilitate painless extraction 3
  • Avoid direct infiltration of local anesthetic into infected tissue 3
  • Surgical incision under local anesthesia may be necessary if gentle probing fails to locate an embedded earring 1

Step 2: Clean the Area

• Clean the infected area thoroughly with antiseptic solution 1
• Avoid benzalkonium chloride as it may be ineffective against Pseudomonas, which is a common pathogen in ear piercing infections 4
• Iodine-based solutions are preferred for cleaning infected piercings 4

Step 3: Antibiotic Treatment

• For mild infections:
  • Topical antibiotics may be sufficient 1
• For moderate to severe infections:
  • Oral antibiotics that cover Staphylococcus aureus and Streptococcus should be used 1, 2
  • Fluoroquinolones (e.g., ciprofloxacin) are recommended if Pseudomonas is suspected 1

Step 4: Monitor for Complications

• Watch for signs of abscess formation, which may require surgical incision and drainage 1
• Monitor for systemic symptoms that might indicate septicemia, which can be potentially fatal 2

Follow-up Care

• The ear can be repierced 6-8 weeks after complete resolution of local swelling and tenderness 1
• When repiercing, choose an unscarred area of the earlobe 1
• Consider using hypoallergenic materials for future earrings (e.g., surgical steel, 14K or 24K gold) to reduce risk of allergic reactions 1, 4

Common Pitfalls and Caveats

• Leaving the earring in place during an active infection can:

  • Impede drainage and prolong infection 1
  • Lead to embedded earrings requiring surgical removal 1
  • Potentially contribute to more serious complications like abscess formation 1
  • In rare cases, be associated with conditions like erosive lichen planus 5

• Failure to distinguish between earlobe infection and auricular perichondritis (cartilage infection) can lead to inappropriate treatment 1

  • Perichondritis requires more aggressive antibiotic therapy, typically with fluoroquinolones 1
  • Cartilage infections can lead to permanent deformity if not treated properly 1

• Minor infections can progress to more serious conditions including perichondritis, abscess formation, and necrosis if not properly treated 1

• Potentially fatal septicemia due to beta-hemolytic streptococci can occur as a complication of ear piercing infections 2