Wounds International, Vol 1, Issue 5Practice Common complications involved in body piercing

Common complications involved in body piercing

15/11/10 | Infection | Cindy M Schorzman

Common complications involved in body piercingAs the prevalence of body piercing has increased in recent years so has the associated list of documented risks and complications. Some of the more common localised dermatologic risks include infection, hypertrophic scarring and keloid formation, and traumatic tearing. This article examines the main risks of body piercing and looks at techniques for management and prevention.


INTRODUCTION
Cosmetic body piercing has become increasingly popular in recent years and may now even be considered a mainstream activity across many social groups. This is especially true in developed countries where up to 51% of the general population may have a piercing[1,2] and the number of individuals with piercings continues to rise[3]. However, as the prevalence of body piercing has increased so has the list of recognised dermatologic risks and complications, some of which can lead to significant long-term cosmetic sequelae.


INFECTIOUS COMPLICATIONS
Infectious complications are the most commonly reported adverse incidents associated with body piercing. The combination of the trauma inherent in the piercing process together with the ongoing presence of a foreign body lends itself toward a risk of infection[4]. Any break in the integrity of the skin can expose a person to the danger of local infections such as cellulitis and abscesses as well as to systemic infection[3].
 
Localised infections are reported in 10-30% of body piercings[5,6]. The rate of infection is influenced by factors such as the anatomic location of the piercing, the experience level of the clinician, hygiene, aftercare,[7] and the types of materials used (nickel alloys are among the most problematic with regard to allergic reaction)[8]. This article explores the anatomic site-specific and host-specific considerations contributing to a risk of localised infection.

Ear piercings
Ear piercings are among the most frequently studied and reported with regard to complication rates and have been thought to largely reflect potential infectious complications associated with other anatomical sites[7] [Fig 1]. Infection is among the most commonly reported complication of ear piercings, occurring in up to 35% of cases[3]. While recent studies reflecting modern piercing techniques have not shown a significant prevalence of serious infection in the general population involving ear piercings (less than 1%)[6], there is a growing body of literature which highlights both the risk and potential serious nature of these infections.

Figure 1 - Ear, tragus and tongue piercings.

 

This is particularly true with high ear piercings that involve the cartilage and these have become increasingly popular over recent years. The available literature suggests that the increased prevalence of high ear piercing has led to an increased risk of morbidity associated with these piercings, including higher incidences of auricular perichondritis and abscess formation[9].
 
Anatomic variations, such as blood supply to the site, can contribute to an increased risk of infection after piercing. While piercing sites in the earlobe heal in approximately six weeks[10], cartilage and tragus piercings [Fig 1] can take up to one year to heal[11]. Of the reported cases of infected cartilage in high ear piercings of the pinna, pseudomonas aeruginosa is most commonly implicated, with staphylococcal and streptococcal infection also reported[12,13].

Because these cartilaginous infections can be difficult to resolve, aggressive therapy earlier in the course of the infection should be considered and empirical therapy of auricular chondritis should include broad spectrum coverage (including antipseudomonal coverage), for example with ciprofloxacin when oral antibiotics are appropriate[12,13]. If these infections are severe or are not rapidly responsive to more conservative treatment, more aggressive measures should be considered, including surgical drainage and intravenous (IV) antibiotics[9]. Although the earlier the infection is recognised and treated the greater the likelihood of successful results, the extent of the consequent ear deformity is unpredictable even with early treatment. For example, the healing process may cause permanent deformity such as 'cauliflower ear'[9].

 

Page Points

  • Infections are the most common complication of body piercing
  • Anatomic variations such as blood supply to the pierced area can contribute to an increased risk of infection