Ear Piercing has been popular from time immemorial. Piercings, at all levels of the pinna, is popular even now. Sometimes even the tragus is pierced. I am an ENT surgeon and this is a public service post.

 Previously seen in rural, but now more among the urban population than before. So what’s the worry?
Traditionally single piercing of the ear lobule’s fleshy part caused little problem.P roper aseptic precautions in the right setup were all that was needed!
But piercing of the cartilaginous part often brings with it multiple problems.

Problems of Piercing in cartilaginous  part

• perichondritis (inflammation of cartilage )
• hypertrophic scar
• keloids
• sometimes even necrosis of the cartilage
• the collapse of the pinna.

The deformity produced in the cartilaginous part is greater and often more severe. Add to it the sensitive nature of cartilage and the prominent site of your ear.This piercing may give you the kind of “look” which is more than what you bargained for!

 So what should you know before you go for an Ear Piercing?

1) Avoid piercing of the cartilage of your ear.

2)Go for Ear Piercing in the fleshy  lower part(lobe)

3)Ensure  Aseptic measures are being taken care of.

The doctor or the piercing clinic representative should be using sterile gloves.

Sterile instruments should be used. Cleaning the ear lobules with betadine solution,

Cleaning the ear lobules with betadine solution, spirit is recommended.

4)If you have a history of a thick raised scar forming in regions with cuts and scars…
AVOID EAR PIERCING especially if you are still in your growing years!

What material should you use while choosing earrings?
Gold, Silver, Platinum, Titanium, stainless steel non-reacting, neutral pure metal.Ring or stud with no ridging. This is important because imitation alloys and even white gold (it contains nickel along with gold )can cause a foreign body reaction.

Inflammation, infections, and allergic reaction predisposes to hypertrophic scar and keloid formation.

Can pain during piercing be reduced?
Yes, it’s possible by topical application of a local anesthetic agent preferably 15 to 20 min before the procedure.

Who can do ear piercing?

ENT surgeon and dermatologist can both pierce the ear aseptically with due precautions. But all of them may not be doing it. Often piercing clinics are the only option and, in that case, you have to use your sensibility to choose the best option!

  What is the care required after Ear piercing?

1)Keep the ear-piercing clean.
After washing hand with soap and water clean the ear lobules with cotton wool dipped in antiseptic solution, twice a day.
2)Rotate the earring in its hole slowly to avoid the build-up of debris.
3)Keep the region dry.
4)Look out for signs of infection. Infection and allergic reactions make the chance of hypertrophic scar, and keloid formation more likely.
5)Don’t try to change the ear-ring/stud before 6 weeks after Ear piercing.
6)Continue wearing ear-ring continuously for 6 months as otherwise the tract will not form and the piercing may close.

 What to do for foreign body reaction to ear-ring?

A granulomatous inflammation due to foreign body reaction may manifest as an itchy, reddish, nodular lesion at the site of the piercing. Taking out the offending object followed by steroid ointment application in proper concentration helps cure the condition in most cases
More aggressive lesions may need intralesional (within the swelling) steroid injections and sometimes even excision. Keep in mind to avoid further piercing at least 6 months after this event and ideally till the growing age of the person is over.

What is Keloid and why you should be careful?

Some people may have an aggressive response of skin repair after surgical nonsurgical trauma to the skin.
It’s characterized by elevated itchy scars after even minor skin lacerations. This occurs due to an over-enthusiastic, poorly regulated proliferation of the cells responsible for skin repair and is mediated by the individual immune system.
The problem with people with this problem going for Ear Piercing is they will develop unsightly nodular lesions on the pinna which are often very difficult to get rid of completely.

 Best treatment options for Keloid

Steroid treatment
Steroid-containing creams and ointment. May work for small lesions. Helps to flatten the lesion and decreases itchiness. Often regains to original size after stoppage of cream.

 For both hypertrophic  scar and keloid:
The serial weekly course of intralesional steroid injection helps decrease the itching, and redness and decreases the size of the lesion. The main reason steroids work is they decrease the hyper-reactivity of the scar-forming tissues. A prolonged treatment up to 6 to 7 weeks may be needed in some cases.

Pros of this treatment:

• Maybe done in an outpatient setting.
• Not expensive
• Less morbidity

Cons of this treatment:

A high level of patient motivation and compliance is needed for weekly pricking with a needle.
There’s often loose extra skin left at the site of lesion, which looks unsightly.
Smaller lesions respond better.

Surgical excision followed by steroid injection at the base of the lesion location.
This mode of treatment  actually gives good results in most cases, especially for large keloids.
The principle of surgical excision for best result in keloid is to give the surgical incision within 1cm of the external border of the lesion. This avoids the involvement of further area of skin.
After excision of the bulk of the keloid intralesional steroid injection is given at the base of the lesion to inhibit further proliferation of fibroblasts. This steroid injection is again repeated weekly till about 6 to 7 weeks for best results.

Laser surgery is also another method of excision. But not much difference in results has been seen compared to regular surgery.
The results for surgery alone are not very good. But surgery along with steroid injection gives quite a good result in the majority of small to medium-sized keloid. Results may, however, vary according to the size of the Keloid and patient profile.

Radiotherapy along with Surgery
Radiotherapy is a definite a last resort.
It’s used only in case of highly disfiguring keloids resistant to other types if treatment.
An important thing to remember is if you have  a tendency to keloid formation, you  should definitely avoid repeat piercings and all nonsurgical types of skin trauma.You should also tell your doctor about this before all surgical treatment.

What’s the Ideal age for skin piercing in Children?

This is a somewhat controversial area. Though there’s no set age for Ear Piercing. It’s better to get it done when the child is able to actively help take care of the ear-piercing site and ear-ring. About 6 to 10 years is a good age when the child is able to understand the process and will be actively interested.

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So pierce your ear or your child’s ear, do it with due precautions. Did you get your ears pierced? Do you plan to get your ears pierced?

Comment below to let me know what problems(if any ) you have faced when you got your ears pierced when you got your ears pierced.

Ear piercing image by Stuart Miles at  freedigitalphotos.net

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