Thursday, December 21, 2006

Body Piercing

Dear Lisa,

I've had my tongue and eyebrow pierced for about a year now, and they've healed perfect, and it's been fine up until now. Just this week they've been sore, and oozing. I don't know what could've made this happen. It would be greatly appreciated if you could answer this. Thank you.


Dear “Bmesarah”,

An Infection is the most common complication arising from piercing. (1) Local infection and bleeding are reported in 30% of piercings.(2) It is possible for a skin infection to occur at a piercing site at any time. In particular piercing sites that have more movement, sites that are more restricted (such as those under tight clothing) or sites prone to moisture are more likely to become infected.(1)

The signs of local infection include redness, swelling, warmth, pain, and drainage from the site.(1) Local infections often can be managed with good hygiene and topical antibiotic treatments, although some cases may require antibiotics given by mouth.(1) When it is suspected that a piercing site is infected, it is important to replace the jewelry after cleaning the area. By leaving the jewelry in place it allows drainage of the site and prevents abscess formation.(3)

An infection at a jewelry site can develop complications, therefore suspected cases need to be cared for and monitored by a Physician or Nurse Practitioner. Cellulitis or abscess formation are two of the possible complications that can develop. Rarer complications, such as infective endocarditis and cerebellar brain abscess have also been reported. (4,5)

A sensitivity to jewelry can also cause a reaction at the piercing site. If your rash began after a switch in jewelry, the composition of the metal should be ascertained. Some popular cosmetic decorative pieces have a high content of nickel or brass which can trigger a hypersensitivity reaction.(6) Other metals such as cobalt and chromium can also cause problems in some people.(1) If a sensitivity is suspected, the removal of the jewelry and replacement with a different type should resolve the irritation. Choosing jewelry containing non-allergic metals such as titanium, silver or gold are a better choice for teenagers with metal sensitivities.(7)

Jewelry of the incorrect size or length can also create problems. A stud of inadequate length can exert pressure on the surrounding tissue, decrease circulation and decrease exposure to air.(8) If you recently switched jewelry and the pieces are a different length or size you may want to switch back to see if the irritation resolves.

Tongue piercings in particular initially require a longer, temporary barbell to accommodate swelling. After the initial healing the barbell should be replaced with a shorter, permanent barbell. This is especially important in order to protect the teeth.(9) If you haven't swithed to a smaller barbell since your initial piercing you may need to check to see if the size is appropriate.

Trauma from contact sports can also cause complications when a teenager has a tongue piercing. If you are involved in sports and recently had a blow to the face or mouth, the piercing could have been affected. An evaluation by your Physician is necessary if this is the case.

The recent trend of “stretching” a piercing site may also lead to complications. The process of stretching by gradually increasing the size and gauge of the jewelry can lead to pain, redness or drainage at the site. (8) If you recently have been increasing the size of your jewelry to stretch your piercing site, it would be a good idea to discontinue this process. Pain, redness and discharge at a piercing site that has been stretched can lead to dislocation or tearing of the surrounding tissue.(10) Although this problem has commonly been found in stretching of the earlobe, stretching of any piercing site can lead to similar complications.

In other cases, problems can originate from the recurrent removal and insertion techniques or from cleaning methods. In some cases irritation can occur from repeated or improper removal and insertion of jewelry. In other cases, cleaning solution may have become contaminated which can cause an infection at your piercing site. This may be a possibility in your case, since you previously had no symptoms and now have symptoms at both sites. I would recommend discarding your present cleaning solution in case it has become contaminated and purchasing a new one.

It is important to always wash your hands first with warm soapy water before cleaning your piercing sites. Discard any cloths, cotton balls or Q-tips used after one application. You should also refrain from touching the cleaning solution container with the swabs after they touch your piercing sites. All of these measures can help prevent your cleaning solution from becoming contaminated.

If your symptoms persits, you develop colored discharge from the site, increased swelling, a fever, increased pain, induration or increased redness, you should contact your Physician.

If you are interested in reading other Pediatric Advice Stories covering this topic:

Tongue Piercing

Painful Earlobes

(1)Larzo M, Grimm Poe S. Adverse Consequences of Tattoos and Body Piercing. Pediatric Annals. 2006.35(3)187-192.
(2)Mayers JB, Judelson DA, Moriarty BW, Rundell KW. Prevalence of body art(body piercing and tattooing) in university undergraduates and incidence of medical complications. Mayo Clinic Proc.2002.77:20-34.
(3)Koenig LM, Carnes M. Body piercing: Medical concerns with cutting-edge fashion. J Gen Intern Med. 1999. 14(6):379-385.
(4)Martinello RA, Cooney H. Cerebellar brain abscess associated with tongue piercing. Clin Infect Dis. 2003. 36:e32-e34.
(5 )Keogh TJ, O’Leary G. Serious complication of Tongue Piercing. J Laryngol Otol. 2001.115:233-234.
(6)Ehrlich A, Kucenic M, Beisito DV. Role of body piercing in the induction of metal allergies. Am J Contact Dermat. 2001.12:151-155.
(7)Grassia T. Treatment of skin issues requires knowing the patient’s needs. Infectious Diseases in Children. 2006.June:42.
(8)Thiem LJ. Body Piercing. Clinicians Review. 2005. 15(1):30-34.
(9)Dunn WJ, Reeves JE. Tongue Piercing case report and ethical overview. Gen Dent. 2004.52:244-247.
(10)Niamtu J 3rd. Eleven pearls for cosmetic earlobe repair. Dermatol Surg. 2002;28:180-185.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Teenagers

No comments: