Auricular infections caused by high ear piercing in adolescents

Community Outbreak of Pseudomonas aeruginosa Infections Associated with Contaminated Piercing Aftercare Solution, Australia, 2021

In April 2021, the South Eastern Sydney Local Health District Public Health Unit (Sydney, New South Wales, Australia) was notified of 3 patients with Pseudomonas aeruginosa infections secondary to skin piercings performed at the same salon. Active case finding through laboratories, clinician alerts, and monitoring hospital visits for piercing-related infections identified additional cases across New South Wales, and consumers were alerted. We identified 13 confirmed and 40 probable case-patients and linked clinical isolates by genomic sequencing. Ten confirmed case-patients had used the same brand and batch of aftercare solution. We isolated P. aeruginosa from opened and unopened bottles of this solution batch that matched the outbreak strain identified by genomic sequencing. Piercing-related infections returned to baseline levels after this solution batch was recalled. Early outbreak detection and source attribution via genomic sequencing are crucial for controlling outbreaks linked to contaminated products. Manufacturing standards for nonsterile cosmetic products and guidance for piercing aftercare warrant review.

National outbreak of Pseudomonas aeruginosa associated with an aftercare solution following piercings, July to September 2016, England

We report a national Pseudomonas aeruginosa outbreak from a common source following piercings between July and September 2016 in England. The multi-agency outbreak investigation included active case finding, microbiological testing of environmental samples and case specimens including Variable Number Tandem Repeat (VNTR) typing and a retrospective cohort study. Overall, 162 outbreak cases (29 confirmed, 14 probable and 119 possible) and 14 non-outbreak cases were identified; all confirmed cases had ear piercings (93% cartilage). Outbreak cases were predominantly female (95%) and had a median age of 18 years (interquartile range: 13-56 years). Nineteen outbreak cases required surgery under general anaesthetic The same outbreak VNTR type (11,3,5,3,3,3,6,4,7) was isolated from bottles of an aftercare solution from a single manufacturer and in specimens from confirmed cases who attended eight different piercing studios supplied with this product. In the cohort study, use of aftercare solution was associated with becoming a case (aOR: 4.60, 95% confidence interval: 1.65-12.90). Environmental, microbiological and epidemiological investigations confirmed that contamination during production of aftercare solution was the source of this national outbreak; highlighting challenges in the regulation of a cosmetic products used in the piercing industry and that guidance on piercing aftercare may need to be reviewed.

[Pseudomonas aeruginosa in post-piercing perichondritis: Two case reports]

The frequency of body piercing has increased in France over the past few years, particularly among teenagers. Piercing can be performed at different sites on the body, especially in the cartilage of the ears. We relate two cases of Pseudomonas aeruginosa chondritis. A 10-year retrospective study at the Marseille University Hospital found no additional pediatric cases. These infectious complications can sometimes be necrotizing. It is therefore important to inform the medical staff on the hygiene measures that need to be respected and the patients on the treatment to follow after the piercing as well as the signs to watch for, possibly indicating chondritis. The esthetic consequences depend on early diagnosis.

Adolescent and Young Adult Tattooing, Piercing, and Scarification

Tattoos, piercing, and scarification are now commonplace among adolescents and young adults. This first clinical report from the American Academy of Pediatrics on voluntary body modification will review the methods used to perform the modifications. Complications resulting from body modification methods, although not common, are discussed to provide the pediatrician with management information. Body modification will be contrasted with nonsuicidal self-injury. When available, information also is presented on societal perceptions of body modification.

Bacterial chondritis complications following ear piercing

BACKGROUND

Body piercing has become widespread and is associated with increased complications. Post-piercing chondritis may lead to severe residual deformity. We aimed to report case patients presenting with post-piercing chondritis in our department and to describe clinical features and treatment.

PATIENTS AND METHODS

We conducted a retrospective study of patients presenting with post-piercing chondritis in the infectious disease department of Tenon Hospital, Paris, France.

RESULTS

We included 21 patients. Fifteen bacteriological cultures were positive (7 Pseudomonas aeruginosa, 5 Staphylococcus aureus, and three other). Dual intravenous antibiotic therapy was administered to 13 patients for a median duration of six days [2-8], replaced by an oral antibiotic therapy for a median duration of 15 days [7-40]. Eight patients received oral antibiotic monotherapy for 10 days [7-30]. Median duration of antibiotic therapy was 16 days. Earring removal was performed for 18 patients. No ear deformity or general complication was reported.

CONCLUSION

Transcartilaginous ear piercing may lead to infectious complications or deformity. In case of chondritis, early administration of an antibiotic therapy active against P. aeruginosa and S. aureus is recommended. Specific guidelines are needed.

Transcartilaginous ear piercing and infectious complications: a systematic review and critical analysis of outcomes

OBJECTIVES/HYPOTHESIS

The purpose of this systematic review was to critically analyze infectious complications and treatment following transcartilaginous ear piercing.

DATA SOURCES

MEDLINE Pubmed database.

REVIEW METHODS

A MEDLINE PubMed database search using free text, including "ear chondritis," "ear perichondritis," "ear cartilage piercing," and "auricle piercing," yielded 483 titles. Based on set inclusion and exclusion criteria, the titles, abstracts, and full text articles were reviewed for inclusion and underwent data extraction. Pooled outcomes are reported.

RESULTS

A total of 29 articles met inclusion criteria, including 66 patients. The mean age of the patients was 18.7 ± 7.6 years (range: 11-49), 87.5% female. Ear deformity was more likely to occur following postpiercing perichondritis of the scapha 100% versus the helix 43% (P = 0.003). Mean duration of symptoms prior to patients seeking medical attention was 6.1 ± 4.1 days. Greater than 5 days of symptoms prior to seeking treatment was significantly more likely to result in hospitalization. Pseudomonas aeruginosa accounted for 87.2% infections. Of the patients with Pseudomonas, 92.3% were hospitalized versus 75% of the patients infected with Staphylococcus aureus. Initial oral antibiotics prescribed did not target the cultured bacterium in 53.3% of cases; of these, 87.5% were hospitalized.

CONCLUSIONS

Transcartilaginous postpiercing infection may lead to ear deformity and hospitalization. Patients (customers) and practitioners must be aware of optimal treatment strategies to minimize associated morbidity. Scapha piercing and delay in presentation are associated with poorer outcomes. Pseudomonas is the most common bacterial infection. Initial antibiotic selection must be optimized accordingly.

Piercing associated perichondritis of the pinna: are we treating it correctly?

Objective:

This paper reports a series of patients with sporadic pinna perichondritis who presented to a district general hospital over a period of 10 years. The data examined included the causative organism, risk factors and pattern of antibiotic use.

Method:

A retrospective analysis of diagnosed cases of pinna perichondritis from 2001 to 2012 was performed. A literature review of pinna perichondritis was carried out using Pubmed with the key words ‘pinna perichondritis’, ‘pinna abscess’, ‘pinna infection’ and ‘piercing’.

Results:

Pinna perichondritis was more likely to result from chondral than lobe piercings. The majority of cases were caused byPseudomonas aeruginosa.

Conclusion:

Most patients were not prescribed anti-pseudomonal antibiotics on presentation. This may result in persistent infection and long-term cosmetic defects.

Jewellery- and ornament-related injuries in children and adolescents

BACKGROUND

Unintentional injuries are the leading cause of mortality and morbidity in children and teenagers in Canada. Few publications have addressed injuries caused by jewellery and ornaments in children.

OBJECTIVES

To examine the mechanisms and the incidence of injuries caused by jewellery and ornaments in children and teenagers, to identify children at high risk for these type of injuries and to recommend specific injury prevention strategies.

METHODS

Data were analyzed from a Canadian database (Canadian Hospitals Injury Reporting and Prevention Program) of a tertiary paediatric centre. All patients between zero and 18 years of age who were diagnosed in the emergency department with jewellery- and ornament-related injuries during a 10-year period (1997 to 2006) were identified. Patients were categorized according to six age groups (younger than one year of age; one to two years of age; two to four years of age; five to nine years of age; 10 to 14 years of age, and 15 to 18 years of age). For each case, the context and the mechanism of injury were investigated.

RESULTS

From a total of 150,771 reported injury cases, 380 (0.25%) were jewellery related. Unlike with most trauma, girls predominate in this kind of injury (n=288; 75.8% of cases). Over one-half of cases (58.1%) were reported for children four years of age or younger. Emergency physicians reported the presence of jewellery as a foreign body in a natural orifice (mouth, nose, ear or genitourinary tract) in 308 cases (81%). No case of intestinal obstruction, strangulation or death was reported. Eleven cases (2.9%) required emergency hospitalization, all for endoscopic evaluation of a foreign body in the airway or in the digestive tract. In the adolescent group, five cases of injuries secondary to piercing were reported.

CONCLUSION

The present study demonstrates that, although jewellery-related injuries are relatively infrequent, some can cause severe injuries that could compromise patients' health. As a primary prevention strategy, doctors and health professionals working with children should make parents and caregivers aware of the possibility of trauma in children wearing or playing with jewellery, especially in the zero- to four-year-old group requiring closer supervision. Specific anticipatory guidance concerning piercing may be helpful to adolescents.

Post-piercing perichondritis

Piercing has become more and more popular among adolescents. The procedure is generally performed by unqualified professionals and carries its risk. Non-sterilized material or inappropiate hygiene increases the possibility of perichondritis and celulitis. The disease is characterized by erythema of the auricula pinna, unbearable pain and fever. Left untreated, the condition progresses with edema along the auricula and abscess formation that may result in ischemic necrosis and a cauliflower anesthetic deformation. The most common bacteria is Pseudomonas aeruginosa. In cases with abscesses, drainage is necessary along with antibiotic therapy guided by cultures and antibiogram. Aim: The aim of this case report was to review the past 10 years of published papers dealing with anatomical aspects of the auricular pinna, the history of piercing and its most common complications. Methods: A case report of perichondritis after “high” ear piercing that required surgical treatment and that progressed with no esthetic loss. Results: Theoretical and practical experience based on a review and a report of a case that progressed satisfactorily. Conclusions: The increased incidence of perichondritis in adolescents should require more elaborated primary prevention measures.

Pseudomonas aeruginosa necrotizing chondritis complicating high helical ear piercing case report: clinical and public health perspectives

BACKGROUND

Auricular or high helical ear piercing is an increasingly widespread fashion trend that is associated with an increased risk of potentially serious post-piercing complications such as auricular perichondritis.

CASE REPORT

An 11-year-old girl developed severe auricular perichondritis following piercing of the upper helical cartilage of her ear at a hairdressing salon. Four days post piercing, she returned to the same salon for a haircut during which the pierced site was manipulated. She presented to her family physician and was treated unsuccessfully with oral cephalexin. She was then referred to an infectious diseases consultant and received antipseudomonal intravenous antibiotics with subsequent resolution. She also required debridement and removal of necrotic cartilage. Public health investigation evaluated potential sources of infection including the piercing gun, disinfectant solutions, and hair cutting spray water bottles. Final culture results of the ear helical aspirate grew Pseudomonas aeruginosa. Pseudomonas aeruginosa was also cultured from one of the water bottles used to wet her hair during the haircut.

DISCUSSION

Although the pseudomonal strains from the water bottle were different than the infecting one, this contamination presents a potential source of wound infection. Damage to the helical cartilage caused by the piercing gun may also have contributed to this infection. Initial empiric antibiotic therapy for these kinds of infection must include anti-pseudomonal coverage. Auricular or high helical ear piercing using a piercing gun is not recommended.

Perichondritis--a complication of high ear piercing

Body piercing has become a fashionable trend in western culture. High ear piercing is common among the adolescent population and complications from this procedure although uncommon can be permanently disfiguring. We describe a case of perichondritis after high ear piercing in an adolescent male. A review of the history of body piercing, complications, risk factors, and treatment is presented.

Otolaryngologic emergencies in the outpatient setting

Disease processes involving the ear, nose, and throat account for millions of office visits to primary care physicians per year. Because of their proximity to the airway as well as critical neurologic and vascular structures, the disease process in each individual case carries the potential for significant complications. Fortunately, improvements in medical care have significantly reduced the prevalence of these complications. As a result of their relative rarity, most physicians may be unfamiliar with the clinical presentation of these entities. This article familiarizes the physician with the pathophysiology and clinical presentation of the more commonly encountered otolaryngologic complications. The physician should seek to rule out the presence of the aforementioned complications in each patient who presents with an otolaryngologic complaint. Any suggestion of their presence should prompt an immediate referral to a subspecialist or an emergency department. It is hoped that continued familiarization with these' disease processes will maintain them as rare entities of medical practice.

Risk factors for cartilage infections of the ear

BACKGROUND

Investigation and case-control study to identify risk factors in a large outbreak in 2003 of auricular chondritis associated with piercing.

METHODS

Epidemiologic, environmental, and laboratory (pulsed-field gel electrophoresis) investigation, and case-control study. Telephone interviews were conducted for 15 cases and 61 controls. Odds ratios were determined for risks of infection.

RESULTS

Of 15 confirmed cases, nine (60%) were hospitalized (median duration 4.4 days) and treated with intravenous/oral antibiotics. Cases required surgical treatment and multiple antibiotics. Risk factors for infection included piercing location and the use of a contaminated aftercare solution. Pseudomonas aeruginosa isolates, nine from patients and four from the aftercare solution, were indistinguishable by pulsed-field gel electrophoresis; one from the sink at the facility differed by two bands.

CONCLUSIONS

This study demonstrates the serious consequences of cartilage piercing, identifies specific risk factors for infection, and suggests the importance of implementation and assurance of safe procedures.

Correction of auricular deformity caused by high ear-piercing: case report

In recent years, high ear-piercing and wearing earrings in the cartilaginous region of the auricle have become popular. The frequent occurrence of subsequent complications also has been pointed out. The present case is of a 17-year-old girl with an auricular deformity caused by infections occurring after piercing in the scapha. The authors performed an auriculoplasty by excision of the deformed cartilage and autologous cartilage graft from the ipsilateral concha. At present, 1 year and 5 months after the operation, no sign of recontracture is noted, and the auricle remains in a gratifying shape.

Jewelry-induced diseases of the head and neck

The desire to modify a person's outer appearance is a phenomenon that can be traced back to the beginning of humankind. Body modifications have been practiced among all cultures around the globe to differing extents. The authors present medical complications through jewelry in a series of 35 consecutive patients. Patient charts were evaluated for age, gender, type and sequelae of injury, complications, and treatment results. The male-to-female ratio was 1:2.2. Most of the recorded complications were related to the new vogue of piercing, with the ear affected most commonly. Usually the complications were minor; however, 2 patients sustained disfiguring damage to their auricular cartilage as a result of high ear piercing, a child nearly asphyxiated on an aspirated earring, and 2 patients experienced severe dysphagia as a result of tongue piercing. The most severe complication was a lethal strangulation injury in a female patient whose necklace got trapped in the headrest of her car seat during a front-end collision.

Recovery of anaerobic bacteria from 3 patients with infection at a pierced body site

We describe 3 adolescents who developed infections due to anaerobes at pierced body sites: the nipple, the umbilicus, and the nasal septum. Anaerobes (Prevotella intermedia and Peptostreptococcus anaerobius) were recovered from pure culture of specimens obtained from 1 patient with nipple infection and were mixed with aerobic bacteria in cultures of specimens obtained from 2 patients (Streptococcus aureus, Peptostreptococcus micros, and Prevotella melaninogenica were recovered from a patient with nasal septum infection, and Bacteroides fragilis and Enterococcus faecalis were recovered from a patient with umbilical infection). The infection resolved in all patients after removal of the ornaments and use of antimicrobial drug treatment.

Ear piercing for individuals with metal hypersensitivity

OBJECTIVE

To describe and evaluate an ear piercing and earring retention method for individuals with metal hypersensitivity.

SETTING

Private facial plastic surgery practice associated with a tertiary care medical center.

METHODS

Thirty-one patients with a history of hypersensitivity to metallic jewelry (62 ears) underwent earlobe piercing with an intravenous catheter.

RESULTS

None of the patients experienced an infection or hypersensitivity reaction. All patients were able to wear nickel-free earrings for short periods without using the shortened catheter.

CONCLUSION

Using the distal shaft of an intravenous catheter as an earring post sheath is a safe and effective technique that allows hypersensitive individuals to wear earrings in pierced ears on a limited basis.

Appearance, cosmetics, and body art in adolescents

Appearance in adolescents is a means of communication, a language expressing self identity. Teenagers explore fashions to make personal statements. Teenagers are significant consumers of various toiletry and skin care products that fill their cleansing, hydrating, and photoprotective needs. They also are enthusiastic consumers of products aimed at adolescent fads, such as decorative hair and nail cosmetics. For some teenagers, the expression of individualism is achieved through body art, such as tattooing and body piercing. Areas of concern are the lack of motivation for sun protection and the risky behavior associated with body piercing and tattooing.

Chondritis attributable to Lactobacillus after ear piercing

A diabetic patient was admitted with ear pain and purulent discharge after "high ear piercing" by a friend. After investigation she was found to have chondritis, complicated by an abscess. Wound cultures grew Lactobacillus species. Patient responded to parenteral antibiotics without suffering cosmetic deformity. Sterile technique, adherence to post-piercing ear hygiene, and avoiding piercing the auricular cartilage may prevent complications associated with ear piercing. Lactobacillus should be included in the differential of pathogens involved in post-piercing chondritis.

Body piercing: what nurse practitioners need to know

Body piercing is a growing trend among today's youth. Chances are, nurse practitioners will be in contact with someone who has a body piercing and/or complication relating to piercing. This article includes the history of body piercing, the environment of piercing parlors, the methods commonly used, site-specific explanations of select piercings, complications, treatment and practice implications. Nurse practitioners need to establish collaborative working relationships with their clients as well as those who do the piercings.

Cosmetics, skin care, and appearance in teenagers

Adolescence is a period of tremendous transformation in the appearance of the body and the evolution of the mind that will eventually lead to adulthood. "Yesterday's child" will need to assume and exert control over these changes. Therefore his/her appearance becomes a means of communication, a language to express his/her pursuit of self-identity. The cosmetic industry has identified teenagers as "powerful" consumers, and offers them various toiletry and skin care products that should fulfill their needs, such as cleansing, hydrating, and photoprotective agents. Certain decorative cosmetics, especially for hair and nails, are attractive to them also. For some teenagers, the expression of individualism is through body art such as tattooing and body piercing. Areas of concern are the lack of motivation for sun protection and the risky behavior associated with body piercing and tattooing.