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Breaking News: Leave It In? Take It Out? EPs Treating More Infected Piercings

Scheck, Anne

doi: 10.1097/01.EEM.0000403704.85379.4d
Breaking News


With overflowing patient loads in emergency departments, a patient with a question about her pierced navel may seem trivial. But as piercing — and we're not talking ears here — goes mainstream, odds are you're going to hear, “I think my piercing is infected.” Or “Why is my pierced belly button dark and peeling?” And “Does saltwater clear up piercing infections?”

These queries are showing up all over the Internet, tossed online for anyone to answer. ( Could it be that physicians are the last person these piercers want to ask? Maybe so, according to some of their postings — and several medical studies, too. “The worst part was sitting and listening to my doctor lecture me on getting the piercing,” wrote one. Another noted: “This [doctor's visit] is something I start to worry about ahead of time but why? It's my body.” (

Body art, tattoos as well as piercings, is now believed to adorn at least a third to half of all young adults. And that demographic — 18 to 25 years of age — may have reason to feel reluctance in seeking medical care, even though medical complications occur in nearly a fifth of the piercings. (J Adolesc Health 2008;42[2]:201.)

But while patients may have a fondness for their own piercings, they and physicians in one ED said they disliked seeing even one facial piercing on a health care professional. (J Gen Intern Med 2005;20[3]:213.) Five years ago, nursing researchers decided to learn more about patients with genital piercings after they heard colleagues make what appeared to be prejudicial pronouncements, including labeling them “sex fiends” who “have lots of STDs and other awful diseases,” as well as asking questions such as “Why would someone do such a thing?” and “Are these people normal?” (Urol Nurs 2006;26[2]:176.)

This past year, a group of doctors citing growing reports of adverse outcomes suggested even ear piercing should be postponed until an age when adequate self-care could be done. (-Internat J Derm 2011;50[4]:467.)

No such debate is occurring among the community of pierced people. In fact, one of the most debatable points among them seems not to be about whether infection is a risk, but whether to remove a piercing once it occurs. Internet advice yields contradictory answers. ( That seems to be a source of some argument among emergency physicians, too. “I think you need to talk to the patient, and ask ‘Do you want to leave it in? Do you want to take it out?'” before making the final decision, said Darin Wiggins, MD, the medical director of the emergency department at Southampton (NY) Hospital.

“No one knows what the best approach is,” said Howard Blumstein, MD, an associate professor and the vice chair of emergency medicine at Wake Forest University School of Medicine in Winston-Salem, NC. But until proven otherwise, that means for safety's sake any foreign object should be removed when infection occurs, said Dr. Blumstein, who is also the medical director of emergency medicine at North Carolina Baptist Hospital Medical Center.

“The treatment — piercing in or out — depends on the severity of the infection,” said Rick Kellerman, MD, the chairman of family and community medicine at Kansas University School of Medicine in Wichita. And when conditions are sterile and the piercing is done at a regulated facility, infection is rare, he pointed out.

One caveat: excessive piercing, even without complications, may signal a mental health problem, according to several studies. Recently, while seeing a woman with multiple piercings — row after row of rings — Dr. Blumstein asked her why she had decorated herself in this way. She told him it was an addiction, and that she was getting treatment for it.

But for the vast majority of kids, piercing doesn't have any particular mental health significance, said Laurence Steinberg, PhD, the Laura H. Carnell professor of psychology at Temple University. “It's most often a fashion statement, or something that's done to fit in with a peer group, or to get attention,” he said. “I suspect that there are lots of different reasons, only some of which are worrisome,” he added. (See sidebar.)

Unlike some in his field, Dr. Blumstein had early experience treating an infected piercing. About 15 years ago, a man with an infection on his pierced penis sought help, but nonetheless tried to prevent the object's removal. The piercing was taken out over his objections, and he was given a course of antibiotics. But the incident underscored the strong belief some patients have, that their piercings should be left alone during treatment, Dr. Blumstein noted.

More recently, a man who needed to have his piercings removed prior to surgery also raised objections. He wanted to know “how a world-class medical institution lacked the right tools” for extracting these metal implants because there seemed to be no specially tailored utensils for doing so. Dr. Blumstein made inquiries to determine if such specific instruments even exist, and it turns out they don't.

The realm of body art seems “relatively untapped” in terms of research, Dr. Blumstein said. Tongue piercing, for example, could interfere with emergency intubation. Such research might mean more focus on the regulation of vendors who provide piercings, and that might lead to more oversight. “I would like to see standards established,” he said.

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A Nice and Honest Person with a ‘Bad' Piercing

By Amelia Berniece



I got a “Monroe” because of the visual and mental appeal. It was body beautification to me. I thought I could pull it off, and it would add more to my exotic features. It was also a sign of my own individuality and independence. So now I have a piercing between the corner of my nose and upper lip. I had wanted it for a couple years. I told myself that if I still wanted it while I was in college, I would get it done at my own expense. About five months into my first year at college, I decided to take the plunge.

I am aware that it is just a phase and I will not have it forever, probably not even next year. But there is no harm in it now. I am able to take it out when I want, and put it back in. When I went to get it pierced, I made sure I researched the place I was going to. I knew I was in good hands, and everything was sterile, with one-time-use piercing tools.

After it was over, they gave me cleaning salts and instructions on a card with their number if I needed anything else. I cleaned it three times a day. Getting this piercing was not to act out but only to experiment with my idea of self, to see whether I can have a “bad” piercing but still know that I am a nice and honest person. Maybe it was to try to prove to people that not everyone with piercings and tattoos are bad people, but that's another story.

Ms. Berniece is a 19-year-old pre-med student. The piercing she describes is named after Marilyn Monroe's beauty mark.

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