What is the appropriate treatment for an infected ear piercing?

Treatment of Infected Ear Piercings

For infected ear piercings, immediately distinguish between simple earlobe infection (treat with earring removal and topical antibiotics) versus cartilage infection/perichondritis (requires urgent fluoroquinolone antibiotics covering Pseudomonas aeruginosa to prevent permanent ear deformity). 1, 2

Initial Assessment: Critical Distinction

The most important first step is determining the anatomic location and depth of infection:

• Test for perichondritis by deflecting the auricular cartilage—acute tenderness indicates deeper perichondrial infection requiring aggressive treatment 1, 2
• Cartilage infections present with painful swelling, warmth, and redness that typically spares the earlobe, occurring most commonly within the first month after piercing 1, 2
• Simple earlobe infections remain superficial without cartilage involvement and represent 77% of piercing complications 1

Treatment Algorithm by Infection Type

For Simple Earlobe Infections (Superficial)

• Remove the earring immediately to prevent embedding and allow drainage 2
• Apply topical mupirocin ointment for very mild infections 2, 3
• Monitor for 48 hours—failure to improve requires escalation of care 2

For Cartilage Infections/Perichondritis (Urgent)

This is a medical emergency requiring immediate antibiotic therapy to prevent permanent cosmetic deformity:

• Start fluoroquinolone antibiotics immediately (ciprofloxacin or levofloxacin) as first-line therapy 1, 2

  • These are essential because Pseudomonas aeruginosa accounts for 87.2% of cartilage infections and is the most common pathogen alongside Staphylococcus aureus and Streptococcus pyogenes 1, 4
  • Alternative options for hospitalization include clindamycin, ceftazidime, or cefepime depending on culture results 1

• Remove the earring to prevent further trauma 2

• Surgical incision and drainage are necessary if an abscess is present—once an abscess develops, preserving good cosmetic appearance of the auricular cartilage becomes extremely difficult 1, 2

• Duration of treatment: Dual intravenous antibiotic therapy for median 6 days followed by oral antibiotics for median 15 days (total median duration 16 days) 5

Critical Timing Considerations

• Symptoms >5 days before seeking treatment significantly increases hospitalization risk 4
• Scapha piercings have 100% deformity rate versus 43% for helix piercings when infected 4
• Initial antibiotics that don't cover the cultured organism lead to 87.5% hospitalization rate 4

Common Pitfalls to Avoid

The most dangerous error is treating cartilage infections with antibiotics that don't cover Pseudomonas aeruginosa—this leads to treatment failure and permanent cosmetic deformity 2

Other critical mistakes include:

• Delaying earring removal in the presence of infection 2
• Failing to recognize perichondritis as distinct from superficial infection 2
• Waiting to see if infection improves before starting appropriate antibiotics for cartilage involvement 4

Special Circumstances

Allergic Reactions (Not Infection)

• Remove the offending jewelry immediately 2, 6
• Apply topical corticosteroids 2, 6
• Switch to hypoallergenic metals (surgical steel, titanium, or gold) to reduce nickel allergy risk 2

Embedded Earrings

• If gentle probing fails to locate embedded jewelry, perform small incision under local anesthesia for removal 7, 2
• This complication is more common with spring-loaded piercing guns in patients with thick, fleshy earlobes 7

Warning Signs Requiring Urgent Care

Seek immediate medical attention for:

• Spreading infection or systemic symptoms (fever, chills) 2
• Formation of an abscess 2
• Failure to improve after 48 hours of appropriate antibiotic therapy 2
• Any cartilage involvement 1, 2, 4

Post-Treatment Guidance

• Wait 6-8 weeks after complete resolution of infection before considering repiercing 2
• For future piercings, choose professionals with proper training and sterile equipment—infections occur in 18.4% of piercings done at body-piercing shops versus 1.9% elsewhere 1, 7
• Consider earrings with locking or screw backs to prevent embedding 2