What is the treatment for an ear lobe infection?

Treatment of Ear Lobe Infection

For a simple ear lobe infection (typically related to piercing), treat any suspected infection with local wound care and oral antibiotics covering Staphylococcus aureus and Streptococcus pyogenes, such as cephalexin 250-500 mg every 6 hours for 7-10 days. 1

Initial Assessment and Diagnosis

When evaluating an ear lobe infection, distinguish between:

• Simple superficial infection of the ear lobe soft tissue - presents with localized redness, warmth, swelling, and tenderness of the fleshy ear lobe 1
• Auricular perichondritis - involves cartilage (spares the ear lobe), presents with painful swelling and acute tenderness on deflecting the auricular cartilage, requires different antibiotic coverage 1
• Embedded earring - common in thick, fleshy ear lobes pierced with spring-loaded guns, may require removal under local anesthesia 1

Critical distinction: Auricular perichondritis typically occurs in the first month after piercing and spares the ear lobe, whereas simple ear lobe infections involve only the soft tissue without cartilage involvement. 1

Treatment Algorithm

For Simple Ear Lobe Infection (Soft Tissue Only)

Antibiotic selection:

• First-line: Cephalexin 250-500 mg orally every 6 hours for 7-10 days 2
• Alternative (if penicillin/cephalosporin allergy): Consider other oral antibiotics active against S. aureus and S. pyogenes 1

Rationale: The most common pathogens in ear lobe infections are Staphylococcus aureus and Streptococcus pyogenes. 1 Cephalexin is FDA-approved for skin and skin structure infections caused by these organisms. 2

Local care measures:

• Remove the earring if embedded or if gentle probing fails to locate it; small incision under local anesthesia (without epinephrine) may be necessary 1
• Clean and debride any wounds within 12-24 hours 1
• If simple earlobe tear present, suture under local anesthesia 1

For Auricular Perichondritis (If Cartilage Involved)

This requires different management:

• Fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) are the treatment of choice because the most common pathogens are Pseudomonas aeruginosa, S. aureus, and S. pyogenes 1
• Alternative options for hospitalization: clindamycin, ceftazidime, or cefepime depending on pathogen 1
• Surgical drainage required if abscess present; good cosmetic preservation of auricular cartilage is difficult once abscess develops 1

Common Pitfalls to Avoid

Do not confuse with contact dermatitis:

• Contact dermatitis from nickel exposure is common (affects ~10% of women with pierced ears) 1
• Presents with maculopapular or eczematous eruption on conchal bowl and ear canal 1
• Treatment: remove sensitizing agent and apply topical corticosteroids 1

Avoid using piercing guns for re-piercing:

• Piercing guns exert high pressure and cannot be adjusted for varying tissue thickness, leading to embedding 1
• Use longer earring posts with adjustable backings to prevent embedding 1

Follow-Up and Re-piercing

• Earring replacement or re-piercing: Wait 6-8 weeks after resolution of local swelling and tenderness 1
• If hole has closed: Re-pierce in unscarred area after approximately 3 months 1
• Monitor for complications: Up to 35% of people with ear piercings develop complications (77% minor infections, 43% allergic reactions, 2.5% keloid formation, 2.5% traumatic tearing) 1