How to treat an infected earring?

Treatment of Infected Earring

For a simple infected earring site (earlobe), remove the earring, clean the area, and apply topical antibiotic ointment; for more severe infections involving cartilage (auricular perichondritis), initiate oral fluoroquinolone antibiotics immediately to prevent permanent deformity. 1

Initial Assessment: Distinguish Infection Type

The critical first step is determining whether the infection involves only the earlobe (soft tissue) or extends to the cartilage, as this fundamentally changes management and prognosis 1:

Earlobe Infection (Simple)

• Presentation: Localized redness, warmth, tenderness, and possible drainage around the piercing site 1
• Most common pathogens: Staphylococcus aureus and Streptococcus pyogenes 1
• Prognosis: Generally benign with appropriate treatment 1

Auricular Perichondritis (Serious)

• Presentation: Painful swelling, warmth, and redness affecting the cartilaginous portion of the ear that typically spares the earlobe 1
• Key diagnostic finding: Acute tenderness when deflecting the auricular cartilage distinguishes this deeper perichondrial infection from superficial skin infection 1
• Timing: Typically occurs within the first month after piercing, especially during warm-weather months 1
• Most common pathogens: Pseudomonas aeruginosa, S. aureus, and S. pyogenes 1, 2
• Critical warning: Minor infections can rapidly progress to perichondritis, abscess formation, and cartilage necrosis with permanent deformity 1

Treatment Algorithm

For Simple Earlobe Infections

1. Remove the earring immediately if infection is suspected 1

2. Clean the area:

   • Gently clean with hydrogen peroxide or warm water 1
   • Remove any drainage or crusting 1

3. Apply topical antibiotic ointment (e.g., mupirocin or bacitracin) to the infected site 1

4. Monitor for progression: If symptoms worsen or do not improve within 48-72 hours, escalate treatment 3

5. Repiercing timeline: The ear can be repierced 6 to 8 weeks after complete resolution of local swelling and tenderness 1

For Auricular Perichondritis or Severe Infections

1. Initiate oral fluoroquinolone antibiotics immediately:

   • Ciprofloxacin or levofloxacin are first-line agents that provide excellent coverage against Pseudomonas aeruginosa, S. aureus, and S. pyogenes 1, 2
   • Typical duration: 10-16 days of therapy 2

2. Remove the earring 2

3. Assess for abscess formation:

   • If an abscess is present, surgical incision and drainage are necessary 1
   • Warning: Once an abscess develops, good cosmetic preservation of the auricular cartilage is difficult to maintain 1

4. Alternative antibiotics for hospitalized patients (depending on pathogen and severity): clindamycin, ceftazidime, or cefepime 1

5. Early dual intravenous antibiotic therapy may be considered for severe cases, followed by oral therapy 2

Special Situation: Embedded Earrings

Embedded earrings are common in persons with thick, fleshy earlobes pierced with spring-loaded guns 1:

• If gentle probing fails to locate the embedded earring, a small incision under local anesthesia (without epinephrine) may be necessary 1
• Any suspected infection should be treated before attempting removal 1
• Prevention: Use longer earring posts with adjustable backings 1

Management of Treatment Failure

If symptoms persist beyond 7 days despite appropriate therapy 3:

1. Reassess for obstructed ear canal preventing medication delivery 3
2. Verify patient adherence and proper technique 3
3. Switch from topical to systemic therapy if initially using topical agents only 3
4. Consider placing a wick if significant swelling is present 3
5. Continue therapy for maximum 14 days total 3

Prevention of Complications

• Avoid piercing guns: They exert high pressure and cannot be adjusted for varying tissue thickness, increasing risk of embedding 1
• Use proper aseptic technique during piercing 4
• Limit piercing to the earlobe only to avoid cartilage complications 4
• Frequent cleansing of the piercing site during healing 4
• Remove earrings at bedtime if postauricular irritation develops 1

Critical Pitfalls to Avoid

• Delaying treatment of auricular perichondritis: This can lead to irreversible cartilage necrosis and permanent ear deformity 1
• Using oral antibiotics without Pseudomonas coverage for cartilage infections: Standard oral antibiotics like amoxicillin are ineffective 1
• Failing to remove the earring: Leaving the foreign body in place impedes healing 2
• Underestimating severity: Up to 35% of ear piercings develop complications, with 77% being infections 1

Allergic Reactions vs. Infection

Contact dermatitis from nickel is common and may mimic infection 1:

• Presents with localized skin discoloration and irritation 1
• Treatment: Avoid triggering metals and apply topical corticosteroids 1
• Consider localized argyria from silver or gold sensitivity 1, 5