HEALTH INSIGHTS

Ear - Pierced

By David A. Thompson, M.D.

March 22, 2017

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Ear Piercing

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Does this describe your symptoms?

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Definition

Area around pierced earring is red, tender, or swollen
Earlobes can also become torn or lacerated

General

Piercing guns should not be used. Two problems with piercing guns are tissue injury and exposure to body fluids from repeated prior use. The Association of Professional Piercers (APP) recommends against using piercing guns.
Individuals should have their ears pierced by someone who is experienced and uses sterile technique.
Reputable piercing studios provide aftercare instructions and these instructions should be followed for the entire duration of the healing time.

Healing Times for Ear Piercings

Healing times vary from person to person. The values below are averages.

Earlobe (soft lower part of ear): 6-8 weeks
Ear Helix (folded rim of skin and cartilage of the upper outer ear) : 6-9 months

Complications of Ear Piercing - Common

Minor complications occur in about 30% of people who have their ears pierced. These complications most commonly happen in the first few days or weeks after piercing.

Contact dermatitis: Contact dermatitis is fairly common and most often is the result of allergic reaction to nickel (contained in some piercing jewelry). Piercing jewelry should be made of hypoallergenic metal. Examples of metals that cause the least amount of allergy are stainless steel, titanium, platinum, palladium, and niobium. Titanium has the least risk of allergic reaction. Even gold posts should be avoided immediately after a piercing, because even higher quality gold can contain trace amounts of nickel.
Embedded clasp: The backing (clasp, ball) gets stuck (embedded) under the skin. The most common cause is that the earring post is too short (the thickness of earlobes varies) or the clasp is squeezed on too tightly. A visit to the doctor is often necessary to extract the embedded clasp.
Local infection: A minor local infection at the piercing site may occur in 10-30% of individuals, even when the piercing is performed in a sterile manner by professionals. Symptoms of a local infection include yellow discharge, crusting, and mild irritation.
Traumatic injury: Tears of skin can occur because of a pulling injury on jewelry. The most common site is the ear lobe and a common scenario is the earring getting hooked on an article of clothing during dressing or undressing.

Complications of Ear Piercing - Uncommon

Auricular chondritis: This is a serious infection of the ear cartilage that occurs in a piercing through the cartilage of the helix. The helix is the folded rim of skin and cartilage of the upper outer ear. This infection can begin weeks after an ear piercing and it usually requires IV antibiotics.
Blood-borne infections - Hepatitis B and C: Blood-borne infections can be transmitted by sharing earrings with other people or through use of un-sanitary piercing needles. Professional piercing studios follow strict sanitation guidelines and utilize sterile single-use piercing needles.
Cellulitis: Rarely a local infection at a piercing site can spread into the surrounding skin and cause cellulitis; symptoms are spreading redness and increasing pain at the site. In such cases oral antibiotic therapy is needed.
Blood-borne infections - HIV
Keloid: A keloid is the medical term for excessive scar formation at wound or surgical site. It develops over months. It occurs because some individuals are simply prone to developing excessive scar formation and not because of how the piercing was performed.

Causes of Pierced Ear Infections

The most common causes of infection are piercing the ears with unsterile equipment, inserting unsterile posts, or frequently touching the earlobes with dirty hands.
Another frequent cause is earrings that are too tight either because the post is too short (the thickness of earlobes varies) or the clasp is closed too tightly. Tight earrings don't allow air to enter the channel through the earlobe. Also, the pressure from tight earrings reduces blood flow to the earlobe and makes it more vulnerable to infection. Often this can be prevented by leaving the clasp at the notch on the post.
Some inexpensive earrings have rough areas on the posts that scratch the channel and can result in infection. Heavy earrings can cause breaks in the skin lining the channel. lnserting the post at the wrong angle also can scratch the channel, so a mirror should be used until insertion becomes second nature. Posts containing nickel can also cause an itchy, allergic reaction.

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When to Call Your Doctor

	Call Your Doctor Now (night or day) If
	You feel weak or very sick Earring tore completely through the ear lobe Skin around the piercing site is split open or gaping Bleeding at the piercing site has not stopped after 10 minutes of direct pressure Part of earring (clasp) is stuck inside the earlobe Ear pain and entire lower ear is red or swollen Ear pain and entire upper ear is red or swollen Ear pain and you have a fever
	Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
	You think you need to be seen
	Call Your Doctor During Weekday Office Hours If
	You have other questions or concerns Symptoms of minor pierced ear infection (e.g., localized redness just at earring site, slight discharge), and not improving 3 days following Care Advice (e.g., cleaning, antibiotic ointment) Swollen lymph node (in front of or behind earlobe) Minor tear in your earlobe and your last tetanus booster was over 10 years ago Small tear in earlobe from earring injury and no tetanus booster greater than 10 years Large thick scar has developed at the earring site during the last couple months
	Self Care at Home If
	Symptoms of minor pierced ear infection (e.g., localized redness just at earring site, slight discharge), and you don't think you need to be seen Small tear in earlobe from earring injury, and you don't think you need to be seen You have questions about how to care for a new ear piercing

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HOME CARE ADVICE

Caring for a Minor Infection at an Ear Piercing Site

Reassurance:
- This sounds like a minor infection that you can treat at home.
- The most important thing to do is to keep the piercing site clean. It's also important to apply an antibiotic ointment, it should get better. I can give you instructions on how to do both of these.
General Care Advice for New Piercings (Less than 6 Weeks Old):
- Leave the earring in at all times. If you take it out, the hole can close, sometimes even within a few minutes.
- Posts should be made out of surgical steel, 14-18 karat gold, or some other metal (e.g., titanium) that does not cause skin allergy. However, some piercing salons recommend that gold posts should be avoided immediately after a piercing, because even higher quality gold can contain trace amounts of nickel.
- Make certain that phones are clean.
- Be careful when brushing your hair.
- Change and use a clean pillow case every 2 days.
- Avoid playing with the earring/jewelry.
- Avoid smoking during the healing period (Reason: it prolongs healing).
- Avoid wearing heavy/large/dangling earrings.
- Avoid hanging any accessories from piercing until it is completely healed.
General Care Advice for Established Piercings (6 Weeks and Older):
- Make certain that phones are clean.
- Be careful when brushing your hair.
- Change and use a clean pillow case every 2 days.
- Avoid playing with the earring/jewelry.
- Avoid smoking during the healing period (Reason: it prolongs healing).
- Avoid wearing heavy/large/dangling earrings.
- Avoid hanging any accessories from piercing until it is completely healed.
Treatment - Cleaning Instructions:
- Step 1: Wash your hands with soap and water.
- Step 2: Soak the area in warm saline (salt water) solution 3 times per day for 5-10 minutes. For ear piercings it is easiest to place a saline-soaked cotton ball directly on the piercing site.
- Step 3: Wash the piercing site with 3 times a day. Use a cotton swab ("Q-Tip") dipped in an ear care antiseptic solution (usually contains benzalkonium chloride). If you do not have ear care antiseptic, you can use just a tiny amount of liquid antibacterial soap (e.g., Dial); be certain to rinse it off completely.
- Step 4: Gently pat area dry using clean gauze or a disposable tissue.
Treatment - Antibiotic Ointment:
- Apply a small amount of antibiotic ointment to piercing site 3 times per day. - Use Bacitracin ointment (OTC in U.S.) or Polysporin ointment (OTC in Canada) or one that you already have.
- Rotate (turn) the earring several times, to prevent the skin from sticking to the post.
Expected Course:
- With proper care, most minor piercing site infections should clear up in a couple days.
- You should see a doctor if it does not improve within 3 days or if it gets worse.
Saline Solution - How to Make It:
- Place 1/2 teaspoon of non-iodized (iodine-free) salt into a cup (8 oz or 240 ml) of warm water. You can use Sea Salt to make the saline (salt) solution.
- Stir the water until the salt dissolves.
Call Your Doctor If:
- Not improved after 3 days
- Pain increases
- Spreading redness occurs
- You become worse

Very Small Tear in Earlobe

General Care Advice for Ear Piercings:
- Make certain that phones are clean.
- Be careful when brushing your hair.
- Change and use a clean pillow case every 2 days.
- Avoid playing with the earring/jewelry.
- Avoid smoking during the healing period (Reason: it prolongs healing).
- Avoid wearing heavy/large/dangling earrings.
- Avoid hanging any accessories from piercing until it is completely healed.
Bleeding:
- Using gauze or clean cloth, apply direct pressure to the area from both sides
- Call back if the bleeding does not stop after 10 minutes
Tetanus Vaccine: If your last tetanus shot was given more than 10 years ago, then you need a booster.
Call Your Doctor If:
- Ear looks infected
- You become worse.

Aftercare Instructions for a New Ear Piercing

General Care Advice for New Piercings (Less than 6 Weeks Old):
- Leave the earring in at all times. If you take it out, the hole can close, sometimes even within a few minutes.
- Posts should be made out of surgical steel, 14-18 karat gold, or some other metal (e.g., titanium) that does not cause skin allergy. However, some piercing salons recommend that gold posts should be avoided immediately after a piercing, because even higher quality gold can contain trace amounts of nickel.
- Make certain that phones are clean.
- Be careful when brushing your hair.
- Change and use a clean pillow case every 2 days.
- Avoid playing with the earring/jewelry.
- Avoid smoking during the healing period (Reason: it prolongs healing).
- Avoid wearing heavy/large/dangling earrings.
- Avoid hanging any accessories from piercing until it is completely healed.
Treatment - Cleaning Instructions:
- Step 1: Wash your hands with soap and water.
- Step 2: Soak the area in warm saline (salt water) solution 3 times per day for 5-10 minutes. For ear piercings it is easiest to place a saline-soaked cotton ball directly on the piercing site.
- Step 3: Wash the piercing site with 3 times a day. Use a cotton swab ("Q-Tip") dipped in an ear care antiseptic solution (usually contains benzalkonium chloride). If you do not have ear care antiseptic, you can use just a tiny amount of liquid antibacterial soap (e.g., Dial); be certain to rinse it off completely.
- Step 4: Gently pat area dry using clean gauze or a disposable tissue.
Saline Solution - How to Make It:
- Place 1/2 teaspoon of non-iodized (iodine-free) salt into a cup (8 oz or 240 ml) of warm water. You can use Sea Salt to make the saline (salt) solution.
- Stir the water until the salt dissolves.
Expected Course:
- First 1-3 Days: There might be some mild bruising, mild swelling, and mild tenderness. Rarely, there might be very slight bleeding (a couple spots of blood at piercing site).
- During Healing Period: You may note some itching at the site. You also may note whitish-yellow fluid (not pus) that coats the jewelry and forms a crust when it dries.
- After Healing Period: Sometimes jewelry will not move freely within the piercing tract; this is OK and you should not try to force the jewelry to move. If you forget to clean the piercing for a couple days, you may note normal but slightly smelly secretions. This should be prevented; thus, it is important to remember to clean the piercing as part of your normal daily good hygiene.
Healing Period - How Long Does It Take?:
- A piercing heals from the outside in; so it can look healed on the outside and still be fragile on the inside.
- Reputable piercing studios provide aftercare instructions and these aftercare instructions should be followed for the duration of the healing time.
- Healing times vary from person to person. The values below are averages.
- Earlobe (soft lower part of ear): 6-8 weeks
- Ear Cartilage: 6-9 months
Call Your Doctor If:
- You have more questions.

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Updated:

March 22, 2017