As a physcian I am often seeing more and more infections following body piercing. I hope that these will serve as some guideline on what to look for and how best to treat these unfortunate complications.
At A Glance Author anonymous Contact [email protected] Artist self Body piercing heal by a process known as secondary intention. This is a process by which the skin from the otside of the piercing slowly grows throught the tract to render the piercing stable. It has been shown in numerous studies that this occurs in a moist environment and luckily this is present in most piercing. This occurs in varing times depending on the depth and location of the piercing. After the initial piercing, the area arond the entry and exit sites is expected to be red and drain frequently. This drainage may be clear, yellow or bloody conbinations of either.
Infections are usually signled by increased pain at the site followed by increased redness in the surrounding area. There may or may not be drainage. It is essential to secure drainage. This can often be obtained with the use of hydrogen peroxide soaks. If the redness continues, medical attention should be sought to prevent cellulitis and damage to underlying structures. It is often best to see medical attention before removign the jewelry. This is to keep the tract open for drainage and to prevent deeper abcess formation.
A common infection that occurs is the presence of granulation tissue at the puncture site. This is heaped up flesh that often drains, bleeds and has a foul smell. This caused by chronic infection that the body is trying to wall off. This is simply treated by applying silver nitrate (AgNO3) to the tissue or the use of a stypic pencil. This cauterizes the tissue and lets the infectin resolve, often very quickly.
Piercings below the nipple line will often become colonized with psuedomonas bactera and candida fungi causing a foul odor without pain. These can be readilly treated using acetic acid irrigations and soaks (white vineagar). It is necesary to soak the wounds and to change the jewerly often as it often is colonized with the same organisms. This colonization is primarily seen in the threads of the jewelry.
A quick note, prior to surgical procedures, metal objects must be removed from the body to prevent injury from electric cautery. Plastic temporary jewlery may be inserted without risk. Tongue jewerly is necessary to remove prior to surgery as it can pose a severe risk of aspiration if emergency intubation is necessary.
Prevention of infection is best by keeping the wounds clean and by ensuring drainage. Drainage is inhibites by the natural healing process. Durign the healing process the body tries to contract the wound. This occurs ar the puncture site and results in the jewelry being excessively tight preventing escape of fluid. Futher, scabbing forms which serves as a plug. Soaking with hydrogen peroxide helps break up the scabbing, decreases bacterial counts and aids in drainage. Moving the jewelry aids in decreasing the contracture at the puncture site. Generally, bacitracin ointment or polysporing ointment is not used in piercings as it tends to be incorporated into the wound and cause significnat scarring and tissue reaction. Bactroban (mupirocin) ointment does not have this complication. In general, however the healing is occuing inside ot the wound away from the ointment.
The use of lidocaine with and without epinepherine is being used often by some piercers to decrease pain. It must be noted that this is a true drug and has side effects. Lidocaine is toxic in high doses and can cause seizures as well as cardiac depression. Epinephrine added to the solution decreases bleeding and increases the durig of the affect but can cause heart palpitations and cardiac problems. Therefore these drugs need to be used very cafefully in areas of high vascularity and absorbance. This is primarily in the gentital region and the tongue. EMLA a topical agent can be applied and occluded with saran wrap or other plastic sustance. This if applied 30 minutes to 2 hours ahead of time will render adequate anesthesia for most piercing if necessary. Furthermore it can be applied to allow for pain control in the immediate post-piercing time frame.
Cartilage piercing deserve special attention. Cartilage by itself has no blood vessels and relies on the surrounding tissue for nutrients. As such it is highly prone to infection. With infection, swelling disrupts the natural protective layer (perichondrium) which supports and feeds the cartilage. With this loss cartilage dies and all support is gone. An example of this is the wrestler's ear or cauliflower ear abnormality. Loss of cartilage in the nose is catastrophic. In any case of cartilage infection medical attention should be sought.
Above all, if there is any concern of infection, medical consultation should be sought. As body piercing increases in popularity more and more physcians are becomining highly skilled in the treatment of compliations. Cartilage infections of anytime should recieve prompt medical attention.
Chris