Introduction
Body piercings involve a small hole that punctures the body fitted with a piece of decorative jewelry. The common sites for piercings are the ears, nose, eyebrows, mouth, nipples, and navel.
The most commonly occurring infectious complication as a result of body piercings is localized cellulitis. If these infections are not identified and treated promptly, they might lead to serious systemic complications (rarely) like endocarditis (an infection involving the heart's inner lining, especially the heart valves), Ludwig angina (bacterial infection involving the floor of the mouth), or toxic shock syndrome (a rare, life-threatening complication occurring caused by bacterial infections).
What Are the Organisms Involved in Body Piercing Infections?
The organisms most commonly associated with body-piercing infections are:
- Skin and Soft Tissue Infections: Staphylococcus and Streptococcus species.
- Cartilaginous Ear and Nasal Structures: Pseudomonas.
- Genital Piercings: Neisseria gonorrhoeae and Chlamydia trachomatis.
- Nasal Piercings: Staphylococcus aureus.
What Is the Pathophysiology of Body Piercing Infections?
The increased risk of infection can be associated with the following:
- Non-sterilized piercing equipment and improper cleaning techniques.
- An individual’s overall hygiene habits.
- Poor piercing aftercare.
Further, the incidence of infection is high in body piercing of the ears due to poor blood supply affecting wound healing. In the case of genital piercings, these infections can affect barrier contraception as well as increase the risk for sexually transmitted diseases.
How Common Are Body Piercing Infections?
The prevalence of body piercing is highest in Individuals between the ages of 24 to 34 years. Out of these individuals, 23 percent experienced similar medical complications with piercings at sites other than the earlobe. One-third of these complications were reported in individuals who did not get the piercings done at a licensed body art studio which leads to increased infection transmission.
How Are Body Piercing Infections Identified?
Body piercing infections are associated with the following symptoms:
- The site of infection is painful, swollen, hot, very red, or dark.
- Blood or pus is noted.
- Feeling flushed (feverish) or chills.
- A general feeling of being ill (malaise).
Skin and soft tissue infections usually have symptoms of localized cellulitis or abscesses like:
- Erythema (redness of the skin).
- Warmth.
- Swelling.
- Tenderness.
- Fluctuance with or without purulent (containing pus) drainage.
Other systemic symptoms include:
- Fever.
- Malaise and tachycardia (increased heart rate) can vary in different individuals depending on the location and dissemination of the infection.
To have a proper idea of the condition and to evaluate possible complications from a body piercing, it is important for the patient to inform the doctor about when the piercing was done, who performed the piercing, and the equipment used for performing the procedure.
How Are Body Piercing Infections Diagnosed?
No extensive testing is required. The diagnosis of infected body piercing is based on clinical presentation. However, in some patients, laboratory testing and imaging may be needed for further evaluation if systemic symptoms like fever, altered mentation, tachycardia, or hypotension are reported. In such cases, laboratory testing and imaging may include complete blood count, renal function, electrolytes, plain film X-ray, or ultrasound.
What Is the Differential Diagnosis of Body Piercing Infection?
The differential diagnosis is usually clear since the complaint is centered on the piercing site. Other possible diagnoses can include the following conditions:
- A retained foreign body.
- Allergic reaction.
- Deep vein thrombosis.
- Sepsis from a disseminated local infection.
- A bleeding disorder that is identified after the initial piercing.
How Are Body Piercing Infections Treated?
The treatment of body piercing infections includes:
- Minor local infections can be treated with the help of a warm compress and prescribed over-the-counter topical antibiotics Bacitracin or Mupirocin.
- Proper coverage of Streptococcus and Staphylococcus oral antibiotics such as Cephalexin or Clindamycin.
- In the case of Methicillin-resistant Staphylococcus aureus, oral Trimethoprim or Sulfamethoxazole provides adequate coverage.
- Infected piercings of the high ear that involve the cartilaginous structures caused by Pseudomonas can be treated with Fluoroquinolone like Ciprofloxacin.
- The incidence of oral piercings is usually low and can be treated with Amoxicillin and Clavulanate. Further, oral alcohol rinses or topical cleaners that contain carbamide peroxide can also help in healing the infection.
- For treating genital piercing infections, medication like intramuscular Ceftriaxone and oral Azithromycin should be used to cover Neisseria gonorrhea and Chlamydia trachomatis.
- If the individual has not taken a tetanus vaccination or booster for the past five years, then the injection should be administered if a body piercing infection occurs.
Proper culture and gram staining of purulent drainage of skin infections is helpful in the treatment of skin and soft tissue infections. However, it is not always required. The recommended treatment for abscesses is incisions and drainage. It is also essential to remove the jewelry and place a loose loop suture instead to maintain the patency of the piercing during the treatment of infection.
The recommended dose duration for treating local cellulitis is five days. However, if there is no improvement in this duration, treatment can be extended.
What Are the Complications Associated With Body Piercing Infections?
The complications associated with piercing infections are usually minor in the case of early identification and treatment with appropriate antimicrobials. However, a delayed presentation can cause severe local skin and soft tissue infections like:
- Abscess formation.
- Airway compromise as in cases of Ludwig angina.
- Nasal septal perforation.
- Endocarditis in case of dissemination to distant sites.
- The complications of antimicrobial use might have a risk of Clostridium difficile colitis.
What Is the Prognosis of Body Piercing Infections?
The prognosis of these infections is usually good. Complications rarely occur as a result of body piercing infections. The antibiotic treatment with incision and drainage of the abscess leads to a good prognosis.
Conclusion
Body piercing has gained immense popularity among the youth. However, these piercings can sometimes cause complications requiring medical attention. Patient education and counseling about the risk of infection before undergoing piercings is an essential step. It is essential to prevent infection by getting the procedure done at a trusted and certified piercing parlor where proper sterilization and hygiene are maintained. Individuals must ask the professional about these details before getting the piercing done to avoid these infections in the future.
