From the Medic: Featuring Dr. Janet L. H. Keating of the Duke Family Medicine Center

As a student health physician at Duke University, I see a number of piercings in the course of a year. Rarely is the piercing a reason for the office visit--more often the piercee is being seen for a sprained ankle or a strep throat. However, on occasion, there is a complication with a piercing that requires medical attention.

When there is a problem, it is usually infection during the healing phase of the piercing. Any type of surgical procedure, whether it is a tongue piercing or a kidney transplant, carries a risk of infection associated with it, even if sterile technique is followed scrupulously. Skin bacteria is almost always the culprit---typically not from the piercing procedure itself but from contact during aftercare. Good hand-washing is first and foremost the prevention for infection in any wound care.

The basic steps in treating wound infection include cleaning the wound, draining infected material, and applying heat to promote circulation and stimulate the body's immune response. Antibiotics are used depending on the location and severity of the infection. For an abscess, which make up the majority of secondary infections from piercing, antibiotics may not be necessary.

Cleaning and drainage generally involve irrigating the wound with a saline solution and removing debris--dead tissue, pus, dirt or other foreign material. In the case of an infected piercing, this is occasionally interpreted by a health care provider to mean removing the jewelry. It is helpful if the piercee understands and is able to discuss with the physician that the jewelry should remain in place to act as a drain. If the jewelry is too large to allow adequate drainage, it could be replaced with a smaller size by a piercing professional. In the rare cases of severe infection, where there is a lot of destruction of tissue in the area, the jewelry may need to be permanently removed and the dead material debrided (cut away) for healing to occur. This should be clearly explained to the piercee if it appears to be necessary.

Moist heat is best for promoting healing of an infected piercing, and here the standard aftercare instruction of warm sea salt solutions applied to the area would still be appropriate. Even more care about hand-washing, avoiding manipulation of the jewelry, and avoiding other trauma to the area from clothing, etc. needs to be observed. Sheets and clothing in contact with the area should be changed at least daily. Also, to again promote the best circulation to the area and the best response by the immune system, good nutrition, avoiding alcohol, and quitting smoking are extremely important, if not essential to the healing process.

Antibiotics are typically necessary if the infection has spread beyond the immediate area of the wound. This as known as cellulitis and occurs when the body can no longer wall off the infection. Redness, warmth to the touch, and extreme tenderness extending more than a half inch from the piercing site would be suspicious for cellulitis. In most cases, early treatment with antibiotics manages this infection before it becomes severe. However, if a client presents with fever and body aches in the setting of an infected piercing, the infection has begun to affect the entire body and is a risk for causing severe illness. This individual needs medical attention immediately and close observation, sometimes in the hospital, in addition to antibiotics, cleaning, drainage, and warm compresses.

One special concern with infection is piercing through cartilage, such as the nose or the upper ear. Cartilage does not have its own blood supply--it depends on the surrounding tissues to provide oxygen and nutrients by diffusion. This makes it more susceptible to infection, and harder to treat when it does occur. Destruction of cartilage by an infection can also lead to deformity of the ear or nasal contours. While most of these infections still clear well with early use of antibiotics, it is a risk that clients should know about.

Good sterile procedure, good piercing technique, and good instructions on aftercare (with regular reinforcement with a client, if necessary) prevent most infections. When an infection does occur, having a piercing-friendly physician or health care provider available to help is the best course. Know who is available in your area. And even if you can't identify someone who is clearly knowledgeable about piercing, most physicians are open to learning and are happy to discuss a case if the piercee permits it. So, don't hesitate to talk to a health care professional about the special needs of infected piercings.