Cartilage Piercing Riskier Than Earlobes

Infection From Stubborn Bacteria More Likely When Upper Ear Is Pierced

Feb. 24, 2004 -- Piercing the cartilage in the upper portion of the ear is more dangerous than earlobe piercings -- and a nasty infection that doesn't respond to many antibiotics may be a reason why.

In this week's Journal of the American Medical Association, Oregon health officials report on a cluster of infections caused by the Pseudomonas aeruginosa bacteria that occurred among customers at a jewelry kiosk. Of the 118 children and teens who had their ears pierced in the six weeks observed, seven developed confirmed cases of the infection and there were another 18 suspected infections.

None occurred from earlobe piercings; only from those done on ear cartilage. Of the confirmed cases, four patients needed surgery and several were cosmetically deformed.

Officials Blame 'Poor Procedures'

"This cluster of cases was attributed to people at the kiosk using poor procedures that led to multiple people getting infected at the same time," says lead researcher William E. Keene, PhD, MPH, of the Oregon Department of Human Services. "But it was because of the location where they were doing this."

These infections resulted from a number of events such as using the same type of piercing device employed at hundreds or thousands of mall piercing kiosks across the country -- an open, spring-loaded "gun" that shoots a stud into the ear. In Oregon, these guns have been banned for cartilage piercings. Now needles or newer encapsulated guns should be used instead.

"With the new encapsulated guns, the stud itself is inside a sealed unit that snaps into place," Keene tells WebMD. "There is no touching of the stud and it's more idiot-proof when people drop the gun on the floor and then use it."

That's especially important with cartilage piercings, because cartilage doesn't have its own blood supply. So if an infection does develop from bacteria on the inserted stud, commonly used antibiotics can be ineffective because there's no blood to transport the medication to cartilage. Earlobes have a blood supply that can better deliver these bacteria-killing drugs.

Stronger Antibiotics Necessary

That may be the real message of Keene's study: "One thing I learned is that infection that occurs in cartilage, in contrast to earlobes, is commonly caused by Pseudomonas," he says. "And everyone with the infection was initially treated with antibiotics that are not effective against Pseudomonas."

For this bacterium in ear cartilage, his study suggests, stronger antibiotics such as Cipro may be more effective than more commonly prescribed drugs like amoxicillin.

"But Cipro is not specifically approved for use in children, which makes primary care doctors reluctant to use it," says Keene. "When these patients saw their family doctors, they were initially prescribed antibiotics used for other skin infections that proved to be ineffective. In fact, one patient was hospitalized not because she was sick but because she needed intravenous medication." In his study, all of those infected from cartilage piercing were between ages 10 and 19.

His study also reinforces the importance of having any body piercing done under sterile conditions. But he stresses the added necessity when it comes to cartilage piercings, which may better be done at a surgical center than at the local mall. He calls for better infection-control training at these piercing kiosks and elsewhere. He notes that at the business where the infections occurred, the same "single-use" disinfectant bottle was repeatedly used, and was often used improperly. That business has since closed.

'Cosmetically Devastating'

Pseudomonas infection typically occurs weeks or months after the initial piercing. "Realize this is not a trivial thing and requires medical attention," he tells WebMD. "While Pseudomonas infection is not life-threatening, it can be cosmetically devastating. Untreated, the cartilage dies and needs to be surgically removed. And without cartilage to maintain the ear's shape, you get these deformities."

His advice for avoiding problems: "It's one thing to say, 'Don't go to a dirty place,' but even if it looks clean, you cannot tell if the gun has been sterilized properly. But people getting their ears pierced should be aware of the potential for problems, especially if they're having cartilage pierced. And they certainly can see the device being used. If it's not a sterilized needle or encapsulated gun, go somewhere else."

SOURCES: Keene, W, The Journal of the American Medical Association, Feb. 25, 2004; vol 291; pp 981-985. William E. Keene, PhD, MPH, epidemiologist, Oregon Department of Human Services, Portland.