What is the management for an infected ear piercing?

Management of Infected Ear Piercings

For infected ear piercings, treatment should include removal of the earring, appropriate antibiotic therapy (fluoroquinolones for cartilage infections), and possible surgical drainage for abscesses to prevent cosmetic deformity and reduce morbidity. 1

Diagnosis and Assessment

• Distinguish between superficial skin infection and deeper perichondritis (infection of the cartilage) by checking for tenderness when deflecting the auricular cartilage - acute tenderness indicates deeper perichondrial infection 1
• Auricular perichondritis typically presents with painful swelling, warmth, and redness in a portion of the auricle that often spares the earlobe 1
• Most infections occur within the first month after piercing, especially during warm-weather months 1
• Common pathogens include Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pyogenes 1, 2

Treatment Algorithm

For Minor Infections (Superficial, Limited to Earlobe)

• Remove the earring to prevent embedding and allow drainage 1, 3
• Clean the area with antiseptic solution 1
• Apply topical antibiotic if the infection is very mild 1
• Monitor for improvement within 24-48 hours 1

For Cartilage Infections (Auricular Perichondritis)

• Remove the earring immediately 1, 2
• Start fluoroquinolone antibiotic therapy (ciprofloxacin or levofloxacin) due to their effectiveness against Pseudomonas aeruginosa 1, 4
• For severe infections or those not responding to oral therapy, consider hospitalization with alternative antibiotics such as clindamycin, ceftazidime, or cefepime 1
• If an abscess is present, surgical incision and drainage are necessary to prevent cartilage necrosis 1, 5
• Continue antibiotic therapy for at least 10-14 days 2

Special Considerations

• Embedded earrings: If an earring becomes embedded, gentle probing may locate it; if unsuccessful, a small incision under local anesthesia (without epinephrine) may be necessary 1, 3
• Allergic reactions: For contact dermatitis from nickel or other metals, remove the earring and apply topical corticosteroids 1
• Repiercing: Wait 6-8 weeks after complete resolution of infection (no swelling or tenderness) before repiercing 1
• Cartilage piercing complications: "High" ear piercings through cartilage have higher risk of serious infection and cosmetic deformity than lobe piercings 4, 6

Prevention of Complications

• Avoid spring-loaded piercing guns for cartilage piercing as they are associated with higher infection rates 3, 6
• Use proper aseptic technique during piercing 3
• Choose piercing professionals with proper training and sterile equipment 1
• For children with pierced ears, consider earrings with locking or screw backs to prevent aspiration 1

Warning Signs Requiring Urgent Care

• Spreading infection or systemic symptoms (fever, chills) 1
• Formation of an abscess 1, 5
• Failure to improve after 48 hours of appropriate antibiotic therapy 1
• Signs of cartilage involvement (perichondritis) which can lead to permanent deformity if not treated aggressively 5, 2

Common Pitfalls to Avoid

• Treating cartilage infections with antibiotics that don't cover Pseudomonas aeruginosa, which can lead to treatment failure and cosmetic deformity 1, 6
• Delaying removal of the earring in the presence of infection 1, 2
• Failing to recognize perichondritis, which requires more aggressive treatment than simple earlobe infections 1, 5
• Waiting too long for surgical drainage when an abscess is present 1