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A 20 year old woman presented to the ear, nose, and throat clinic with auricular perichondritis two days after piercing the helix of her left ear with the aid of a piercing gun. Two thirds of the upper part of her auricle was swollen, red, and tender. The lobule (which does not contain cartilage) remained intact, which indicated that the infection was perichondritis and not simply cellulitis (fig 1). The patient was treated with ciprofloxacin by mouth for a period of one week; by then the infection was entirely resolved.
Body piercing has become a widespread phenomenon in the last decade. Although other parts of the body have become subject to this new ritual of body piercing, the ear remains a most common site, with piercing of the ear cartilage (“high” ear piercing) gaining more popularity. Although the various parts of the auricle do not carry different risks for complications, the cartilage of the ear tends to become infected more often than the lobule after piercing. Staphylococcus aureus and Pseudomonas aeruginosa are the most common bacteria.1
The use of guns for piercing cartilage presents an additional risk of perichondritis. The gun applies shear forces to the perichondrium, which may slip off the cartilage. An avascular cartilage (which is normally nourished by the perichondrium), may then become necrotic. Abscess formation and loss of cartilage are potential complications that often require surgical intervention. Despite timely treatment, including antibiotic therapy, drainage, and debridement, an unsightly deformity (“cauliflower ear”) may result.2
The treatment of choice for auricular perichondritis is fluoroquinoline antibiotics, such as ciprofloxacin, since they show good antipseudomonal activity in addition to their effect against staphylococci. They also penetrate well into the cartilage. However, their use is limited to patients who are more than 18 years old because of their potential damage to young developing cartilage.
Although our treatment was successful, this case demonstrates the potential hazards of piercing cartilage, mainly in the ear and nose. Perichondritis can end with a very unsightly ear or nose, which may eventually turn out to be beyond repair. Physicians as well as the clientele of body piercers should be aware of this risk.