What is the treatment for infections involving ear piercings?

Treatment of Infected Ear Piercings

For minor earlobe infections, remove the earring immediately and apply topical antibiotics; for cartilage infections, start fluoroquinolone antibiotics immediately due to Pseudomonas risk. 1

Distinguish Infection Type First

The critical first step is determining whether you're dealing with a superficial skin infection versus deeper perichondritis, as treatment differs significantly:

• Check for acute tenderness when deflecting the auricular cartilage - this indicates deeper perichondrial infection requiring systemic antibiotics rather than just topical treatment 1
• Auricular perichondritis presents with painful swelling, warmth, and redness that typically spares the earlobe 1
• Most infections occur within the first month after piercing, especially during warm-weather months 1

Treatment Algorithm by Infection Severity

Minor Earlobe Infections (Superficial)

• Remove the earring immediately to prevent embedding and allow proper drainage 1
• Apply topical antibiotic ointment if the infection is very mild 1
• Monitor for 48 hours for improvement 1

Cartilage Infections (Perichondritis)

• Start fluoroquinolone antibiotics immediately (ciprofloxacin or levofloxacin) due to their effectiveness against Pseudomonas aeruginosa, the most common pathogen in cartilage infections 1, 2
• Remove the earring 1
• Common pathogens include Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pyogenes 1
• In one study of 21 patients with post-piercing chondritis, dual intravenous antibiotic therapy was administered for a median of 6 days, followed by oral antibiotics for 15 days 2

Abscess Formation

• Surgical incision and drainage are necessary to prevent cartilage necrosis and permanent cosmetic deformity 1
• Continue fluoroquinolone coverage 1

Critical Pitfalls to Avoid

• Never treat cartilage infections with antibiotics that don't cover Pseudomonas aeruginosa - this leads to treatment failure and permanent ear deformity 1
• Do not delay earring removal in the presence of infection, as this allows continued embedding and worsens outcomes 1
• Do not miss perichondritis by failing to assess cartilage tenderness - superficial appearance can be deceiving 1

Warning Signs Requiring Urgent Care

• Spreading infection or systemic symptoms (fever, malaise) 1
• Formation of an abscess 1
• Failure to improve after 48 hours of appropriate antibiotic therapy 1

Special Considerations

Allergic Reactions

• Remove the earring and apply topical corticosteroids 1
• Nickel allergy is common; recommend hypoallergenic metals (surgical steel, titanium, or gold) 3

Embedded Earrings

• If gentle probing fails to locate an embedded earring, a small incision under local anesthesia may be necessary 1
• This complication is more common in children and requires professional removal 1

Post-Treatment Management

• Wait 6-8 weeks after complete resolution of infection before considering repiercing 1
• Repiercing should be done in an unscarred area 4
• Consider earrings with locking or screw backs to prevent future embedding, especially in children 1

Prevention Counseling

• Choose piercing professionals with proper training and sterile equipment 1
• Piercings performed in body-piercing shops had significantly higher infection rates (18.4%) compared to those done elsewhere (1.9%) 3
• High ear piercing through cartilage is associated with more serious infections and disfigurement compared to earlobe piercing 5