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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Monday, March 5, 2012

Body Piercings and Infections

By Rod Moser, PA, PhD

Pierced Ear

The American Journal of Clinical Dermatology published a study which stated that 20% of all body piercings end up becoming infected at some point. This is not surprising. Any extra holes put through the skin can become infected, either from our own surface bacteria or an unwanted gift from others.

Piercings in the earlobe tend to be the most popular site, so those of us in clinical practice are more likely to see them infected. I just saw a five-year-old with one today. The more recent the piercing, the more likely it will become infected, although I often find infections in sites that are decades old.  I often see infants with ear piercings already—not really a good idea until after the baby is six months old and their immune systems are better equipped to fight infections. Fortunately, most infections are localized and can be easily treated at home with good hygiene and topical antibiotic creams or ointments. When piercings in the ear extend beyond the lobe onto the rim of the pinna, the cartilage, or tragal area, infections can become more serious and painful, often spreading into the adjacent soft tissue (cellulitis). These need to be treated much more aggressively with oral antibiotics.

Many parents ask me to pierce their child’s ear, instead of going to the mall. I respectfully refuse because I do not want to open this bag of worms. In the event that the piercings are uneven, I don’t really want to deal with this unnecessary issue. Let someone else do it. Besides, as soon as I pierce an ear, someone will be making appointments for me to pierce other sites, like eyebrows, the nose, a tongue, the umbilicus, and elsewherea. Each one of these sites has their own issues with healing and potential complications and infections.

My daughter pushed the limit of piercings and tattoos when she became a legal adult. As a loving parent, my disapproval had no effect whatsoever. One day, while getting a haircut from my barber friend, an ultra-conservative Morman, he stopped and watched a news story on television. The story was about piercings, and right there on the screen was my daughter getting her tongue pierced.

Without knowing who she was, Ed the Barber said, “How would you like to be her father?”

I responded, “I am her father.”

At first, he didn’t believe me. I showed him her picture in my wallet. He apologized for being judgmental. As a friend, I forgave him and we never talked about it again. Since I love my risk-taking daughter, I forgave her, too. She is now in her mid-thirties and more conservative. She only has simple earlobe piercings now (as far as I know). The other sites have long healed and are a distant memory of her rebellious youth.

Most body piercing sites will eventually heal when you no longer put jewelry in them. What doesn’t heal spontaneously are large-gauged ears. Those huge holes must be surgically closed. A 19-year old patient of mine recently got a taste of this reality when he tried to join the military. He had to have them cosmetically repaired before they would consider him as a candidate. Incidentally, insurance companies rarely pay for cosmetic procedures like this.

A few times per year, I will have to repair a torn earlobe when an earring has been caught on something and tears the area. Several times a month, I am digging out an embedded post. When I worked in family practice, I did see a variety of genital piercings (and tattoos), but my current practice spares me from dealing with those. Most of my patients are under 18 now, so the non-ear piercings are usually the tongue, nose, and belly button area.

I am not a fan of tongue piercings, but I have to say that I have never seen one that was infected. The constant washing of these sites with saliva seems to have a protective effect. Nasal piercing can be problematic, and I do treat a few secondary infections, mostly piercing involving the septum. Belly-button piercings can take several weeks to heal properly, so secondary infections are relatively common, but easy to treat.

Tiny earrings can cause issues even when they are not in the ears. My wife takes out her earrings all over the house. I find them on end tables, the bedside table, and of course, on the bathroom counter. I am always fishing them out of the sink or searching for them in the carpet. I don’t want the dogs eating them. One of my dogs would eat anything. He is a perpetual two-year old.

Toddlers and crawlers do find and eat things they find on the floor, like earrings. In most cases, an ingested earring will pass on through without issues. If a woman is so inclined to dig through diapers for a lost earring, they have my blessing. Personally, I don’t think I would want to wear an earring that went on that particular journey, even if it were well-cleaned. Ingested foreign bodies, like those that are sharp, can pose a risk of perforation of the bowels. I recently heard a news story of a child that died after swallowing a push-pin. Another terrible thing for a child to ingest would be one of those little button batteries. Should this happen, surgery is recommended to remove them due to the perforation risk.

Over the years, I have grown more accustomed to various piercings. It is rare that I am shocked anymore. People do have the right to “body modifications” and adornments, but things that look way-cool when you are a teenager look absolutely ridiculous when you are an adult.  When you make these important decisions, also take time to ponder your future.

Photo: Ablestock.com

Posted by: Rod Moser, PA, PhD at 9:49 am

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