rec.arts.bodyart: Piercing FAQ 6--The Healing Process & Healing Problems
Anne Greenblatt
Last-modified: September 08, 1998
Posting-frequency: Monthly
URL: http://www.landfield.com/faqs/bodyart/piercing-faq/
Summary: This posting contains information about body piercing. Anyone
interested in the subject and/or who wishes to read/post to
rec.arts.bodyart should read the Piercing FAQ first.
The rec.arts.bodyart Piercing FAQ is divided into 29 parts:
1--Introduction
2A--Jewelry Materials
2B--Jewelry Sizes & Designs
2C--Facial Piercings & Their Suggested Jewelry
2D--Body Piercings & Their Suggested Jewelry
2E--Genital Piercings & Their Suggested Jewelry
3--Getting A New Piercing
4A--Professional Organizations, Piercing Instruction
4B--Professional Piercers - United States - Alabama - California
4C--Professional Piercers - United States - Colorado - Iowa
4D--Professional Piercers - United States - Kansas - Nevada
4E--Professional Piercers - United States - New Hampshire - North Dakota
4F--Professional Piercers - United States - Ohio - Pennsylvania
4G--Professional Piercers - United States - Rhode Island - Wyoming
4H--Professional Piercers - Canada
4I--Professional Piercers - Beyond N. America
4J--Professional Piercers - Beyond N. America Cont'd
5--Care Of New Piercings
6--The Healing Process & Healing Problems
7--Healed Piercings
8--Historical Information
9--Resource List
10A--Personal Experiences - Facial & Unisex Piercings
10B--Personal Experiences - Genital Piercings
10C--Personal Experiences - Genital Piercings Cont'd
10D--Personal Experiences - Genital Piercings Cont'd
11A--Jewelry Manufacturers
11B--Jewelry Manufacturers Cont'd
11C--Jewelry Manufacturers Cont'd
This section includes:
6--The Healing Process & Healing Problems
6.1 The Healing Process
6.1a Abandoning a Piercing
6.2 Scars
6.3 Irritations & Infections
6.4 Piercing Migration / Rejection
6.5 Metal Sensitivities
All texts written and (c) 1998 by Anne Greenblatt unless otherwise noted.
Please see Part 1 of the FAQ for information regarding copyright and
dissemination of the FAQ.
DISCLAIMER! The Piercing FAQ contains material of a sexually explicit
nature. The information contained in the Piercing FAQ should not be
construed as medical advice.
Finding a piercing-friendly doctor is less difficult than finding a
piercing-knowledgeable doctor. While a doctor may have the best intentions,
s/he may not be knowledgeable enough about piercings to identify problems
caused by inappropriate jewelry, inappropriate piercing location, or a metal
allergy. Too often doctors assume that every problematic piercing is
infected when the problem can be attributed to other factors.
Some people are apprehensive to visit a doctor in case of a problem or be
open about their piercings because they feel that the doctor will
disapprove. You should be comfortable enough with your doctor to disclose
information pertinent to your health care. Your doctor should be
professional and should not be morally judgemental or express personal
disapproval about your piercings.
6.1 THE HEALING PROCESS
Piercings heal by forming epithelial cells along the inside of the piercing
to protect the body from the foreign object. These epithelial cells form a
tubelike layer of skin along the inside of the piercing. After the
epithelial layer has formed, usually the second and third month, the
piercing may constrict around the jewelry. The epithelial layer can easily
be dislodged; do not force the jewelry to rotate without first applying an
appropriate cleaning solution and warm water. The piercing may need to soak
in warm water to allow the skin to expand so that the jewelry can be
rotated.
Factors which may cause the epithelial layer to become dislodged include
injury, piercing migration or rejection, wearing a ring that is too small in
diameter or wearing jewelry that has a rough finish. Please see Part 6 of
the Piercing FAQ for information about healing problems.
All piercings produce a lymph discharge during the healing period. The
discharge is sticky, white to off-white in color and dries to a crusty
formation around the openings of the piercing and on the jewelry. This
discharge should not be confused with pus which is yellow to green.
Once the epithelial layer forms it must toughen and strengthen while
granulation tissue forms beneath it. This process can require upwards of 6
months to a year. As the piercing becomes more cohesive on the inside the
entrances will round inwards, like a donut hole, and the piercing will
become more flexible and relaxed around the jewelry.
If you plan to keep your piercing do not remove your jewelry for any length
of time while it is healing. If a jewelry change is necessary because of a
metal sensitivity or dimension concerns the change must be continuous to
prevent the piercing from shrinking or closing.
Most body piercings require at least a year or two before they can be left
empty without the risk of growing closed. After the piercing has toughened,
it will probably not grow closed if jewelry is not worn for a length of
time but may shrink considerably, in which case stretching with an
insertion taper is required to reinsert the jewelry.
6.1a Abandoning a Piercing
Whether or not the piercing completely closes depends on how old the
piercing is, how toughened it is, and the gauge of the piercing. Older,
toughened piercings, especially those that have been stretched, will shrink
but probably will not close.
If the piercing does not close it will collect dead skin cells and dirt
which can contribute to the formation of cysts. To prevent accumulations
insert a thin taper or jewelry through the piercing periodically to
facilitate cleaning the piercing.
If the piercing has not yet healed and is still producing a discharge it
will close quickly if the jewelry is removed. If the piercing is new,
scarring will be minimal. Continue to clean your piercing until it closes.
Soaking the piercing is beneficial in drawing-out discharge and preventing
it from accumulating within the piercing. Jewelry should not be removed if
the piercing is infected.
If the piercing has only recently healed the interior will probably close.
If the entrances of the piercing have started to round inwards, permanent
dimple-like scars will result. The interior of the piercing may form a scar
which can be felt as a knot or raised line under the skin; this scar tissue
usually shrinks over time.
An abandoned piercing may be repierced after the scar tissue has softened
and reabsorbed. The second piercing is usually made behind the scar tissue
from the initial piercing. Piercing through the scar tissue can be difficult
and in some cases more painful. If the piercing was abandoned because of
rejection, repiercing behind scar tissue will not insure a successful
piercing.
6.2 SCARS
Any penetration of the skin can result in a scar. In the case of
piercings, excessive scarring can result in an unattractive or
uncomfortable piercing.
Keloid scars are hard, raised, bulky formations of primarily collagen scar
tissue which spreads beyond the boundaries of the wound. Keloids often grow
or spread with increased or continued irritation. The tendency towards
developing keloids has been noted to be hereditary and to affect people with
darker skin.
Cartilage piercings appear to be particularly prone to keloids because the
piercings involve multiple layers of tissue which heal at different rates.
Hypertrophic scars tend to be fleshy and stay within the boundaries of the
injury. Affected piercings may appear to have excess or protruding tissue
at the entrances. In some cases hypertrophic scar tissue is reabsorbed as
the piercing heals or when the source of irritation is eliminated.
Mechanical stress and irritation contribute to both keloid and
hypertrophic scarring. Mechanical stress includes:
- changing jewelry before the piercing has fully healed
- stretching the piercing too fast or too soon
- injury to the piercing
- friction or pressure against clothing / other body parts / other jewelry
- wearing jewelry of inappropriate dimensions (includes gauge, width, length)
- wearing jewelry that is too thin to withstand friction or pressure
exerted on the piercing
- piercing placed at an inappropriate angle to the tissue
- piercing in an area that changes shape with body movements
Scarring may also indicate migration; the pressure between the jewelry and
the skin is too great and the piercing is migrating to relieve the
pressure (see section 6.3).
Attempting to treat scar tissue without evaluating and eliminating the
cause of irritation often does not succeed over the longterm.
Methods of Treating Scars
Keloid scars can increase in size with ongoing irritation caused by the
jewelry. Removing the jewelry at the first signs of keloid formation and
allowing the piercing to heal closed will often get rid of the keloid, or
minimize its size. However, do not remove the jewelry if there is any sign
of infection.
One dermatologist I have consulted about keloids says that once a keloid
begins to form the jewelry will continue to irritate the area and the scar
tissue will continue to grow. He noted that cortisone or steroid injections
with the jewelry in place may help shrink the keloid some but that as long
as the jewelry is in place the keloid will never completely disappear.
Also, the injections tend not to work so well in cartilage layers. His
advice is to remove the jewelry.
Scar tissue can be excised under local anesthetic by a dermatologist or
plastic surgeon. Excision of a keloid scar does not guarantee that the scar
tissue will not return; in some cases excision results in a larger scar.
Hypertrophic scars are more successfully excised.
Keloid scar tissue is sometimes treated with injections of cortisone or
other steroids.
Over-the-counter Hydrocortisone ointments and creams containing from 0.5% to
1% cortisone can be used to shrink keloid scar tissue. Fluocinonide Cream,
containing 0.05% cortisone, is often prescribed to shrink keloids in people
who are prone to keloid scarring resulting from cuts and scratches. Efficacy
of treating keloids resulting from piercing has not been determined. Do
not allow the ointment inside the piercing.
Some people have treated scar tissue with Hydrogen peroxide gel or solution.
Hydrogen peroxide should be used sparingly and use should be discontinued if
the piercing shows signs of irritation. Do not allow hydrogen peroxide
inside the piercing.
Vitamin E, applied during healing, may decrease the formation or chance of
formation of scar tissue. Some people are allergic to Vitamin E; an allergy
is indicated by a rash of small bumps.
Some people successfully use an aspirin and water paste to dissolve scar
tissue on oral piercings. If you choose to try this method please be aware
that you may run the risk of seriously damaging oral tissue if the solution
is left in place too long or if you are allergic to aspirin.
A relatively new product, Rejuveness is a silicone gel sheeting available in
the US by prescription and over the counter. According to the product
webpage, "ReJuveness is clinically proven effective in the management of
existing scars and preventing new ones. ReJuveness softens, smooths and
flattens scars, and restores skin to its normal texture and color. Developed
through advanced medical research and proven effective on hypertrophic and
keloid scars, ReJuveness is used by plastic surgeons and burn centers around
the world." Efficacy of treating piercing scars (old or with jewelry
intact) is not mentioned.
http://www.rejuveness.com, US 1-800-361-0778, Canada 1-800-361-0778
6.3 IRRITATIONS & INFECTIONS
All piercings produce a lymph discharge during the healing period. The
discharge is sticky, white to off-white in color and dries to a crusty
formation around the openings of the piercing and on the jewelry. This
discharge should not be confused with pus, which is yellow or green.
Redness, inflammation and swelling during the first few days is not unusual.
Prolonged redness and inflammation may indicate a mild infection, a
sensitivity to the metal or aftercare product, or irritation due to
mechanical stress. Mechanical stress is most often caused by friction
against clothing or other parts of the body, wearing jewelry of
inappropriate dimensions, or inappropriate placement of the piercing.
Over-cleaning the piercing, failure to thoroughly rinse the piercing after
using soap, or using an antiseptic or soap that is too drying can cause the
openings of the piercing to become red, overly dry and cracked. Most
piercings do not require cleaning more often than 2 or 3 times a day.
Sensitivity to the aftercare product is usually indicated by extreme itching
and burning upon application of the product or a rash of small bumps
surrounding the piercing. If you are sensitive to anti-bacterial soaps or if
you find soap too drying try a formula made for sensitive skin and dilute by
applying only the lather.
Some people have noticed that the condition of their piercings deteriorates
or the healing process is slowed by relocating to an area with harder water.
The body usually adjusts to the change. If the irritation continues, use
bottled or distilled water until the piercing has healed.
Laundry detergents containing stain-fighting enzymes should not be used.
The enzymes can destroy epithelial (healing) cells and delay healing.
Piercings in moist areas which lack air circulation and which are irritated
by friction sometimes develop extrusions of red, inflamed soft tissue which
may form a ring or flap around the entrances. Most commonly affected are
labia, scrotum, and guiche piercings and the inside entrance of navel
piercings. This condition is usually not painful and is not necessarily a
symptom of infection. Usually the tissue recedes as the piercing heals.
Continue twice a day cleaning with a mild cleanser, especially after
perspiring, but do not over-clean. The area should be kept as dry as
possible. In the case of navel piercings dry the inside of the navel using a
cotton swab. In the case of genital piercings wear cotton underwear and
absorbent panti-liners. If possible, eliminate sources of irritation.
Follicular Cysts
Follicular cysts appear as red bumps adjacent to one side of the piercing
entrance and usually produce a discharge and sometimes blood. Follicular
cysts are usually caused by a pore blockage or build-up of dead skin
cells and dirt within the piercing. Continue to clean the piercing with an
antibacterial agent and apply hot compresses or soak the piercing in hot
salt water. Hydrogen peroxide gel has also been used successfully to dry
out follicular cysts. Do not allow hydrogen peroxide inside the piercing.
Infections
The most frequent causes of infection is touching the piercing or the
jewelry with unwashed hands or contact with unclean items such as clothing,
bedding and hair.
Infections are not inherent to piercing and should be treated seriously. A
mild, localized infection is indicated by a discharge of yellow pus, pain,
redness, inflammation (the area feels hot to the touch), and swelling. Dark
yellow or green pus indicates a more serious infection.
If an infection develops the jewelry should be left in place to allow the
infection to drain. If the jewelry is removed the openings of the piercing
will close, trapping the infection, which can create an abscess. An abscess
is indicated by a darkening of the surrounding tissue. Occasionally an
abscess will form even if the jewelry is left in place. An abscess usually
requires treatment with oral antibiotics and may require excision.
A piercing with a mild infection should be cleaned with an appropriate
aftercare product twice a day as suggested for aftercare aftercare (see Part
5 of the FAQ).
Hot salt water soaks and compresses help drain infections and increase
circulation to the piercing. 1/2 teaspoon sea salt or table salt to one cup
water is suggested. Epsom salt (hydrated magnesium sulfate) is not the same
chemical composition as sea salt or table salt (sodium chloride) and should
not be used. Suggested soaking regimen is 10 to 15 minutes once or twice a
day. The tub or container used for soaking should be disinfected using a
household disinfectant or bleach solution. If more than one piercing
requires soaking, disposable cups are recommended to prevent spreading an
infection from one piercing to another. The cloth used as a compress should
be disposable or washed in a bleach solution between uses. A compress can be
rewarmed in a microwave oven.
Some people use over-the-counter antibiotic ointments to treat mild
infections. However, according to the US Food and Drug Administration:
"OTC first-aid antimicrobials are for use only up to one week. If an
injury persists or worsens after this time, the label warns consumers to
stop use and consult a doctor. The products are not for existing infections,
animal bites, sunburn, punctures, or eye injuries. Nor should they be used
for cuts, scrapes or burns needing medical care." (1)
If you choose to use an antibiotic ointment it should be applied sparingly
after the piercing is cleaned thoroughly for a maximum of seven days. If the
infection does not respond or worsens within three days or produces dark
yellow or green pus contact a physician. Oral antibiotics may be required to
treat the infection.
If untreated, a localized infection may develop into a systemic infection or
cellulitis. A systemic infection occurs when bacteria and toxins are spread
throughout the body by the bloodstream. Symptoms of a systemic infection
include fever, chills, joint aches, and an overall feeling of weakness. A
systemic infection can be life-threatening if not properly treated.
Treatment usually requires oral and intravenous antibiotics.
Symptoms of cellulitis include swollen lymph-nodes, red streaks on the skin,
fever and chills. The affected area may be extremely red, raised, and
painful, and the skin may develop an orange-peel-like texture.
Prolonged Healing
Prolonged healing is indicated by failure of the piercing to complete the
final stages of healing. The piercing will form the epithelial layer but it
may be weak and easily dislodged. The piercing continues to produce a
discharge. The entrances of the piercing may remain ragged and do not round
inwards. Prolonged healing is often caused by mechanical stress on the
piercing.
Mechanical stress includes:
- changing jewelry before the piercing has fully healed
- stretching the piercing too fast or too soon
- injury to the piercing
- friction or pressure against clothing / other body parts / other jewelry
- wearing jewelry of inappropriate dimensions (includes gauge, width, length)
- wearing jewelry that is too thin to withstand friction or pressure
exerted on the piercing
- piercing placed at an inappropriate angle to the tissue
- piercing in an area that changes shape with body movements
Prolonged healing may indicate migration or rejection (see section 6.3) or a
metal sensitivity (see section 6.4). Prolonged healing may also be caused by
chemical irritation, or using an inappropriate aftercare product (see Part
5). Wearing jewelry that is scratched or underpolished will irritate the
piercing and prolong healing.
References:
"What's This Bump on My Piercing?" pamphlet, Gauntlet, Inc., 1997,
http://www.gauntlet.com
(1) "OTC Options: Help for Cuts, Scrapes and Burns" by Dixie Farley, May
1996 issue of the FDA Consumer Magazine,
http://www.fda.gov/fdac/features/496_cuts.html
6.4 PIERCING REJECTION / MIGRATION
Piercing migration and/or rejection is indicated by the piercing becoming
narrower and more shallow. Dimple type scars usually appear behind the
piercing, where the jewelry was placed originally. A piercing which is
migrating quickly will develop scabs where the jewelry was placed
originally. Migration and rejection prolongs healing; the entrances of the
piercing will be red and will remain ragged. In cases of already relatively
shallow piercings such as the eyebrow piercing, the jewelry will become
visible through the skin.
Frequent Causes
One of the most frequent causes of migration and rejection is mechanical
stress on the piercing. Mechanical stress includes:
- injury to the piercing
- wearing jewelry of inappropriate dimensions (includes gauge, width, length)
- friction or pressure against clothing / other body parts / other jewelry
- piercing placed at an inappropriate depth or angle to the tissue
- piercing in flat areas or areas that changes shape with body movements
Injury to the piercing can result in tearing or detachment of the epithelial
layer, the newly formed tube-like skin lining the interior of the piercing.
The epithelial layer can be torn if the jewelry is pulled or tugged sharply
or if the jewelry forced to rotate when the piercing has constricted around
it. The piercing may need to soak in warm water to allow the skin to expand
so that the jewelry can be rotated. If the epithelial layer is dislodged
completely the piercing must form a new layer. If the epithelial layer
frequently tears, the jewelry should be checked for rough, underpolished
areas or scratches. Jewelry that is underpolished or scratched will often
adhere to or tear the epithelial layer.
Wearing jewelry of inappropriate size or design creates pressure on the
piercing. Rings which are too small in diameter constrict the piercing and
cause the entrances of the piercing to migrate to conform to the tight
curvature of the ring. If a straight barbell is used through a flat area the
balls will create pressure against the skin behind them, causing the
piercing to migrate forward. A curved barbell will eliminate pressure
between the barbell balls and the skin.
Jewelry that is too thin in gauge is more easily rejected. Wearing jewelry
that is too thin increases the risk of the piercing being torn or ripped
completely through if the jewelry is pulled. Thicker gauges are recommended
for areas where pressure on the piercing cannot be avoided. For example,
navel piercings can migrate or reject from the pressure exerted by
waistbands. A navel piercing performed at 14ga may heal without incident if
waistbands are avoided, but then begin to migrate when the wearer resumes
wearing tight waistbands across the piercing.
Wearing jewelry that is too thick and heavy in a new piercing can also cause
problems. Too heavy jewelry may cause the piercing to migrate or reject. The
gauge must not be so thick that the strength of the tissue is compromised.
A piercing should not be attempted if not enough tissue is available to
support the piercing. Some piercings are simply not anatomically feasible
for some people. If the piercing is too shallow the piercing is more easily
rejected.
Piercings made through flat areas and areas which changes shape during body
movements are more likely to migrate or reject. The optimum area to be
pierced is one in which the piercing will be perpendicular to the tissue,
like an earlobe. The more a piercing deviates from perpendicular, the
greater the pressure between the jewelry and the tissue. Pressure is also
created if the piercing is placed at an inappropriate angle to the tissue.
The more a piercing deviates from perpendicular, the greater the pressure
between the jewelry and the tissue.
A rejected piercing may be repierced after the scar tissue has softened and
reabsorbed. The second piercing is usually made behind the scar tissue from
the initial piercing. Piercing through the scar tissue can be difficult and
in some cases more painful. Repiercing behind scar tissue will not insure a
successful piercing.
If you decide to abandon a migrating or rejecting piercing be sure that the
piercing is not infected. Keep the area clean by continuing your aftercare
regimen until the piercing has sealed.
6.5 METAL SENSITIVITIES
The metals used for body jewelry are chosen because of their "body friendly"
qualities. However, some metals are more biocompatible, or biologically
inert, and thus considered more hypoallergenic than others.
A metal sensitivity is evident by contact dermatitis, which can range in
severity from mild itching and redness to swelling and a red rash of
fluid-filled bumps or flaking skin in the area of contact (under finger
rings or watches, around necklaces). Some people are sensitive to some
metals and not to others. In some cases a metal sensitivity is acquired
after a certain degree of exposure.
Many metal sensitivities can be attributed specifically to nickel
sensitivity. Certain gold alloys contain nickel and copper and silver.
Stainless steels contain nickel. In the case of 316L, only a very minute
amount is released because of the specific composition of 316L. Grades other
than 31L will release a greater amount of nickel. People who are sensitive
to steel and gold alloys can often wear niobium or titanium without an
adverse reaction. Titanium and niobium are elemental metals and are not
alloys. Sensitivities to niobium are rare but not unheard of; in some cases
the sensitivity is caused more by the quality of the finish than by the
metal itself. For information about metal alloys and jewelry qualities,
please see Parts 2A and 2B of the Piercing FAQ.
An extreme metal sensitivity often causes a rapid rejection of the jewelry
which usually manifests immediately. The entrance and exit holes of the
piercing will enlarge and gape around the jewelry in the body's attempt to
rid itself of the jewelry. The piercing will itch and secrete a clear
discharge as part of the histamine response. If you experience these
symptoms you should contact your piercer immediately. The piercing may be
saved by switching to a more biocompatible metal.
A sensitivity to an aftercare product(s) can exhibit similar symptoms.
However, an aftercare product sensitivity is usually accompanied by a rash
of small bumps. If you suspect that you are allergic to a particular
product, discontinue its use and thoroughly irrigate the piercing and rinse
the affected area with water, preferably distilled. Consult your piercer or
Part 5 of the FAQ for alternative aftercare products. If the condition
persists contact a physician.
A less extreme metal sensitivity can cause prolonged healing. Prolonged
healing is indicated by failure of the piercing to complete the final stages
of healing. The piercing will form the epithelial layer but it may be weak
and easily dislodged. The piercing continues to produce a discharge. The
entrances of the piercing may remain ragged and do not round inwards.
Because prolonged healing can be caused by other factors such as migration
or rejection (see section 6.2), consult an experienced piercer to eliminate
other causes. People who experience prolonged healing while wearing steel or
gold are often able to heal their piercings after switching to titanium or
niobium. Often, they can resume wearing steel or gold after the piercing has
completely healed and toughened. Some people only experience prolonged
healing wearing steel or gold in piercings which usually require longer to
heal.
Some people who are extremely sensitive to metals have worn monofilament
nylon or teflon with which to heal their piercing. In some cases metal
jewelry could be worn after the piercing had healed.
References:
Andres, Greg. "Will America Go Nickel-Free?" Accent Magazine, October 1994.
Numerous summaries of studies of metal sensitivity and ear piercing jewelry
are available on HealthGate <http://www.healthgate.com/>
No scientific studies specifically regarding metal sensitivity and body
piercing jewelry have been conducted.
--
Anne Greenblatt
Manager of the rec.arts.bodyart Piercing FAQ
Piercing Exquisite
http://www2.ba.best.com/~ardvark/
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