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Diagnosis: Hypertrophic Scar Formation from Navel Piercing

Filippone, Lisa M. MD

Emergency Medicine News: May 2006 - Volume 28 - Issue 5 - p 20
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Dr. Filippone is an assistant professor of emergency medicine at Drexel University College of Medicine and the director of the division of emergency ultrasound at Mercy Hospital of Philadelphia.

On further questioning, the patient admits to having a prior navel piercing. She noticed that it seemed to be migrating toward the skin surface as her abdomen got larger, so she removed it. She subsequently developed scarring, which left her skin discolored. The other skin change seen in this image is the increased pigmentation of the linea alba, now referred to as the linea nigra.

Body piercing has become very popular in Western society among the general population, not just youth. It is prudent to review some of the basics with respect to body piercing as well as potential complications that may result.

The earlobes are still the most frequently pierced body part. Other commonly pierced sites include oral, nasal, eyebrow, nipple, navel, and genital. Piercing is done at a piercing salon or tattoo parlor, but home piercing (piercing parties) is frequent as well. Piercing is usually accomplished by using a spring-loaded “gun” or by using a hollow needle with a cork.

Multiple case reports of viral hepatitis as a result of improperly sterilized equipment, particularly from spring-loaded guns, have been reported in the literature. In fact, Canadian Blood Services will not accept blood from a donor who has had body piercing within a year. (RN 1998;61:26.) At this time, the American Heart Association does not specifically address antibiotic prophylaxis for patients getting body piercings (JAMA 1997;277:1794), but there have been reports of bacterial endocarditis after nipple and navel piercings in patients with surgically corrected congenital heart disease. (Ann Thorac Surg 2001;71:1365; Pediatr Inf Dis 2003;22:94.)

The size and shape of the jewelry placed also depends largely on the site pierced. Too small a gauge will result in irritation and inflammation with the piercing eventually migrating through the skin. The type of metal used in jewelry should be one that has a low risk of allergy. Surgical stainless steel, niobium, and titanium rarely produce an allergic response, but nickel and chromium should be avoided because of high prevalence of reactivity.

The healing time depends largely on the site pierced, but in general ranges from three weeks to nine months. Mobile areas or those that are subject to frequent friction take longer. The navel tends to take nine months while the earlobe only takes about six weeks to heal. The most common complications seen with all piercings include contact dermatitis, infection, hematoma, hypertrophic scars, and keloid formation.

The ear is the most commonly reported site of infection, but this is likely because it is the site most commonly pierced. Most mild infections can be treated with warm compresses and topical antimicrobials with the earring left in place. More extensive infections require oral or intravenous antibiotics and removal of the earring. If there is concern about maintaining the integrity of the hole, a sterile nylon suture or Teflon catheter with silicone tubing can be placed in the hole while the surrounding skin heals. (Aesthetic Plast Surg 1996;20:343.) Traumatic lacerations also are common with this site.

High-ear piercings deserve special mention. These are done through the cartilage in the superior portion of the ear. Besides the risk of hematoma that may lead to deformity, infections of the perichondrium and cartilage itself may result. These may be caused by the typical skin flora, but often are the result of Pseudomonas aeruginosa. Abscess formation and surgical drainage may be required.

Figure

Figure

Like the ear, the nose can be pierced through only the soft tissue of the nares or through the cartilage in the septum. As with high-ear piercings, piercing of the nasal cartilage can result in a septal hematoma and deformity if not properly drained. Ear and oral piercings also may result in foreign body aspiration.

Oral piercings may involve the lip, cheek, uvula, or tongue, with the tongue currently most common. Complications unique to these piercings include damage to the teeth and gingiva. Dental fractures, acute glossitis, and even Ludwig's angina have been reported.

Navel piercing is very common and interestingly is associated with higher risks of infection and prolonged healing. This is thought to be the result of the constant friction that occurs with waistbands. As in the patient above, new changes in body habitus may lead to migration of jewelry toward the skin surface and subsequent scarring.

Like navel piercings, nipple piercings tend to take longer to heal and may have delayed onset of infection. There is debate on the effect on lactation in women. Milk ducts can become blocked by the piercing or by subsequent scar tissue. Jewelry may interfere with latching on by the infant.

As with oral piercings, the genitalia are pierced in multiple sites. In women, the clitoris and labia are frequently pierced. In men, piercings may be through the skin of the scrotum, the foreskin, or the urethra (known as the Prince Albert). All of these piercings make barrier methods of contraception less effective. Piercings through the urethra may interrupt urinary flow. Other complications seen with male genital piercings include paraphimosis and priapism.

Some patients may delay seeking care for complications because of fear of judgment from health care workers. The emergency physician must remember to inquire about piercings and be aware of their potential complications.

© 2006 Lippincott Williams & Wilkins, Inc.