WHITE PAPER
IN OFFICE vs MALL-STYLE EAR PIERCING
By Julie Black-Peart, MPAS, PA-C
December 17, 2017
Why Pierce? - The History
Piercing is done for many reasons. Throughout history it has been performed as a right of passage, for cultural or religious reasons and as a means of self expression. There is no medical reason or benefit to piercing; however, for just about every female around the world, there comes a time when she will have her ears pierced. The trend is steadily growing among males and older adults; whether for a first or additional piercing(s) to earlobes or other body parts, a practice known as body art. However, the largest population seeking piercings are adolescents and young adults. It is for this reason, the American Association of Pediatrics (AAP) published guidelines for medical professionals, Adolescent and Young Adult Tattooing, Piercing, and Scarification, with an emphasis on informing providers about educating parents and patients of the risks and social determinants of these practices. (1) The article provides a broad presentation of issues related to piercing. This article; however, will focus on piercings of the earlobe only.
Be it purely vanity or time to change one's look, there are many opinions, professional and personal, about the necessity, pros and cons of this common procedure. The important thing to remember, however, is that ear piercing is a minor surgical procedure. It should never to be taken lightly and should always be done by a licensed professional in a clean controlled environment, using aseptic techniques. Given this is the best scenario for one to have piercings done, the question remains - why do people go, and parents take their children, to the mall for ear piercing? The simplest answer - because it’s free with the purchase of earrings. The downside, is that it is done by a profoundly under trained individual who is unable to medically manage any complication that could arise during the procedure. Is this who you should trust yours or your child’s ears to? Absolutely not!
People have been piercing ears for centuries, evidenced by archeological findings of piercings that date back more than 5000 years. (2) The ears of newborn girls in Latin America are often pieced right after a baby is born. (3) In the Hindu religion, generally between the ages of 3 and 5 years, there is a ceremonial earlobe piercing of boys and girls called Karnavedha Sanskar (sacraments). But, for what reason? For Latinas, it is cultural. Where years ago, ear ornamentation often signified office or rank among cultural elite. For Hindi, it is considered beneficial to the child’s health. (3, 4) Whatever the reason, the greater concern is increased risks with self-piercings and those done at many of today’s popular mall kiosks and primarily costume jewelry stores. The basics of this issue are addressed henceforward.
Who’s Piercing Who?
Once done primarily by pediatricians, the practice of ear piercing has fallen out of favor, in large part because the AAP does recommend piercing until children are old enough to decide if they want to do it on their own. (1) To a much lesser degree, insurance companies classify piercing as a cosmetic procedure which they do not reimburse for; and, perhaps now, clinicians also find the process too time consuming to make room in their busy schedules, even while the AAP recommends piercings be done in an office setting.1 It appears this scenario may have helped pave the way to a booming emergence of shopping mall piercing kiosks and stores. Even worse, it has people taking to piercing themselves and others, and at so-called piercing parties. People, primarily teens and young adults, do it because they do not see piercing as a true medical procedure and take the risks for granted. They do not understand the potential for ear piercing disasters such as infections, allergic reactions, keloids and the overall risks of performing piercings themselves.
I once encountered a mother who used to work at a particular mall fashion jewelry store. She wanted her daughter’s ears pierced by a medical professional, because she was not at all comfortable taking her own child to the mall. She recounted her experience of watching a video as part of a short training and piercing someone's ears shortly thereafter. Although we did not discuss further details about her minimal training, one can see similar testimonials of this lack of training on social media, where there is no shortage of said “ear piercing technicians” reporting the same thing. And, I was able to find an official (looking) training course outline from one of the popular mall accessory stores online. It detailed a forty minute session that made no mention of using aseptic techniques beyond, “Clean hands with hand sanitizer and wear gloves,” and directed technicians to place the used surgical pen back in the drawer! (5) What?! For use on the next person, and the next? Not safe or sanitary at all. And nowhere did it instruct trainees to inquire about health related issues such as family history of keloids or contact allergies. These questions must be asked, given that piercings can or should not be done when there is a family history of keloids. This is based on specific age parameters and family history, to determine if piercing should absolutely not be done or can be considered. (6)
Imagine this. As some people are squeamish about needles, needless to say, they are likely to have the same or similar fear of being pierced; and, are may be prone to anxiety and fainting. A clinician will ask appropriate questions before piercing and is prepared to manage a woozy or fainting piercing client. But, if a client became faint at the mall, someone would likely need to dial 911 if they didn’t know what to do.
At Clinical Piercing, clients receive a higher level of care, not attainable at a mall-style piercing location.
An Infection Waiting to Happen
A common possible outcome of any ear piercing is infection, something that can occur wherever the setting. However, by far, the biggest culprit is poor sanitary standards at the time of piercing. Albeit, not a sterile procedure, piercings must occur in a clean establishment in a controlled setting. The standards of proper aseptic technique must be upheld throughout the piercing procedure.
Watch and learn. Simple, yet important, steps to reduce the risk of infection are too often thrown to the wayside by piercing technicians. Can you say “infection waiting to happen?” You’ve likely seen it yourself. If you take a moment to reflect on piercings you’ve stopped to watch in the mall. Think, and suddenly, the epiphany will hit you, that you’ve seen the poor technique before. If not, you need simply to watch one of the many social media video posts of ear piercings to see this impending disaster. Look for piercers with no gloves, one glove, unsanitized or unwashed hands; and, hands that leave the piercing area and touch various items without being re-washed, sanitized or re-gloved before touching the clients ears; thereby contaminating them before proceeding to pierce. It makes this author cringe!
The Bacteria Culprits
Staphylococcus aureus (S. aureus) is a common bacteria causing ear piercing infections called chondritis. A more dangerous strain of this is MRSA (methicillin-resistant Staphylococcus aureus). One that is resistant to typical antibiotics used to treat S. aureus and that can cause significant disfigurement if not recognized and treated right away. Another bacteria that can cause serious complications is Pseudomonas aeruginosa. Each of these microorganisms deserves special consideration, particularly when it comes to piercing cartilage, because they are often associated when there is significant pain and disfigurement of the ear. Unfortunately, even if caught and treated early, the outcome may still be the same. (7)
People are piercing cartilage now more than ever. It is not recommended, because cartilage does not have the protective structure of being well vascularized, like earlobes. Without good blood flow to bring infection fighting cells to the area, infection are more likely to occur. Therefore cartilage piercing is not done by Clinical Piercing.
The Solution
Certainly, knowledgeable clinicians pay careful attention to infection controls and are charged with taking steps to minimize the chance of infections. Although it is impossible for anyone to guarantee that an infection will not occur during any type of piercing, having the procedure done by a licensed clinician, in a controlled environment, minimizes the risks. Together, with clear aftercare instructions and cooperative clients following through, during and after the procedure, the concerns of mall-style piercing can be greatly relaxed, and the chance of infections and poor piercing outcomes significantly reduced.
​
References
1. Breuner CC, Levine DA, AAP THE COMMITTEE ON ADOLESCENCE. Adolescent and Young Adult Tattooing, Piercing, and Scarification. Pediatrics. 2017;140(4):e20171962
2. Hesse, Rayner W. (2007). Jewelrymaking through History: an Encyclopedia. Handicrafts Through World History. Greenwood Publishing Group. ISBN 0-313-33507-9.
3. Karnaveda samskara - The Ear Piercing Ceremony. Retrieved from: http://www.hearty-india.com/2012/04/karnavedha-samskara-ear-piercing.html
4. Ears Pierced at Birth for Latin American Girls. Published on September 13, 2010 by Wade Shepard. Retrieved from: https://www.vagabondjourney.com/ears-pierced-at-birth-for-latin-american-girls/
5. Overview of Lesson Plan: How to Perform an Ear Lobe Piercing. Retrieved from: https://vanishakasandas.files.wordpress.com/2015/05/ear-piercing-lesson-plan-updated1.pdf
6. Relationship Between Age of Ear Piercing and Keloid Formation
Joshua E. Lane, Jennifer L. Waller, Loretta S. Davis. Pediatrics May 2005, 115 (5) 1312-1314; DOI: 10.1542/peds. 2004-1085
7. Manca, D. P., Levy, M., & Tariq, K. (2006). Case Report: Infected ear cartilage piercing. Canadian Family Physician, 52(8), 974–975. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1781501/