What causes a swollen earlobe and how is it treated?

Swollen Earlobe: Causes and Treatment

Most Common Causes

A swollen earlobe is most commonly caused by infected ear piercings, allergic contact dermatitis (especially nickel allergy), trauma with hematoma formation, or furunculosis (infected hair follicle). 1, 2, 3

Infected Ear Piercing

• Remove the earring immediately if infection is present, as continued presence allows embedding and worsening infection 2, 3
• Nickel is the most common contact allergen, affecting approximately 10% of women with pierced ears 1
• Most infections occur within the first month after piercing, especially during warm weather 3
• Common pathogens include Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pyogenes 3

Allergic Contact Dermatitis

• Presents with erythema, edema, scaling, and itching rather than acute pain 1
• Nickel, silver, cosmetics, soaps, and plastics in hearing aids are common triggers 1
• An erythematous streak may extend down the pinna where drops or allergens contact the skin 1

Trauma and Hematoma

• Shearing forces of moderate intensity cause hematoma formation in the earlobe 4
• The high ratio of surface area to mass makes the auricle vulnerable to injury 4

Furunculosis (Localized Infection)

• Infected hair follicle presenting with otalgia, localized tenderness, focal swelling, and pustular lesions 1
• S. aureus is the most common causative agent 1

---

Treatment Algorithm

Step 1: Assess for Piercing-Related Infection

If piercing is present and infected:

• Remove the earring immediately by a healthcare provider 2, 3
• Start fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) to cover Pseudomonas and Staphylococcus 2, 3
• The American Academy of Pediatrics recommends fluoroquinolones despite theoretical risks in children because permanent ear deformity from untreated Pseudomonas infection outweighs these concerns 2
• Continue antibiotics for 7-10 days until complete resolution 2
• If earring is deeply embedded, use local anesthesia without epinephrine for removal 2
• Clean the site with hydrogen peroxide or warm water using cotton-tipped swabs 2
• Keep the area dry using cotton saturated with Vaseline during bathing 2

Critical warning: Do not treat with antibiotics lacking Pseudomonas coverage, as this leads to treatment failure and potential cartilage necrosis 2, 3

Step 2: Identify Allergic Contact Dermatitis

If no infection but swelling with itching and scaling:

• Remove the sensitizing agent (earrings, hearing aids, topical products) 1, 5
• Apply topical corticosteroid drops or ointments for 7-10 days, potentially extended to 2 weeks if symptoms persist 5, 3
• Alternative: Tacrolimus 0.1% ointment or pimecrolimus 1% cream if steroids are contraindicated or ineffective 1, 5
• Contraindicated in children under 2 years and immunocompromised patients 5
• Avoid neomycin-containing products, as neomycin causes reactions in 5-15% of patients with chronic ear conditions 1, 5

Proper application technique:

• Position patient lying down with affected ear upward 5
• Fill the ear canal with drops along the side 5
• Perform gentle to-and-fro movement of the pinna or tragal pumping 5
• Remain in position for 3-5 minutes 5

Step 3: Manage Furunculosis

If localized pustular lesion with focal swelling:

• Apply local heat 1
• Perform incision and drainage if fluctuant 1
• Prescribe systemic antibiotics covering S. aureus 1

Step 4: Treat Hematoma

If history of trauma with blood collection:

• Evacuate hematoma using sterile technique 4
• Apply pressure dressings to prevent reaccumulation 4
• Hematoma organization or chondritis causes permanent disfigurement if untreated 4

---

Critical Pitfalls to Avoid

• Do not delay earring removal in the presence of infection, as this allows continued trauma and embedding 2, 3
• Do not use topical antibiotics alone for established infection with purulent drainage; systemic antibiotics are required 2
• Do not confuse allergic dermatitis with bacterial infection—dermatitis presents with itching and scaling rather than acute pain and purulent discharge 1, 5
• Do not incise and drain lesions unless diagnosis is certain, as pilomatrixomas and other benign tumors can mimic abscesses 6
• Do not allow patients to scratch or insert objects (including cotton swabs) into the ear, as trauma perpetuates inflammation 5

---

Warning Signs Requiring Urgent Escalation

• Spreading infection or systemic symptoms (fever, malaise, lymphadenopathy) 2, 3
• Formation of an abscess requiring surgical drainage 2, 3
• Failure to improve after 48 hours of appropriate antibiotic therapy 2, 3
• Any involvement of auricular cartilage, which can progress to permanent cosmetic deformity 2, 3

---

Prevention and Follow-Up

• Wait 6-8 weeks after complete resolution before considering repiercing 2, 3
• Use longer earring posts with adjustable or locking backs to prevent future embedding 2, 3
• Choose hypoallergenic metals (surgical steel, titanium, or gold) to reduce nickel allergy risk 3
• Chronic dermatitis requires long-term maintenance with intermittent anti-inflammatory treatment and regular emollient use 5