Excerpt From: Complications Of Ear Piercing: Treatment And Prevention William M. Hendricks, M.D., Asheboro, NC Today, ear piercing, sometimes with two or more pairs of earrings, is very popular especially among adolescents and young adults. In fact, in some ethnic groups, earrings may be inserted by relatives in the groups, neonatal period. Current fashion trends include "body piercing": earrings or tiny barbells called labrets are inserted anywhere on the body. Although there are few serious risks associated with ear piercing, the incidence of complications following ear piercing is quite high. The frequency of complications, however, does not appear to differ significantly with the medical qualifications of the person performing the procedure or the technique used. The complication rate was 36 percent when done by a friend or relative, 31 percent when done by medical office personnel, and 28 percent by department store staff. The chance of complications was 33 percent when needles were used, 29 percent when a staple gun was used, and 22 percent when sharpened studs were used to pierce the ears. Cortese and Dickey studied seventy-three nursing students with pierced ears and found that thirty-eight (52 percent) had experienced one or more local complications. These included allergic contact dermatitis (19 percent), inflammation (15 percent), bleeding (15 percent), infection with purulent drainage (15 percent), nonpurulent drainage and crusting (12 percent), cyst formation (3 percent), and torn earlobes (1 percent). Many of these complications can be prevented if simple guidelines are followed. Ear piercing using nickel-alloyed studs or clasps causes considerable risk of nickel sensitization. In the United States nickel sensitivity is ten times more common in women than in men, probably because of women's increased exposure to nickel, especially in jewelry. Since more men at this time are wearing jewelry and having their ears pierced, the incidence of nickel allergy among men will probably increase. Fischer et al found that all studs and clasps, even those made of stainless steel, released some nickel, although the almost poreless surface of stainless steel prevented most iron and nickel from being released. They also determined that gold or silver plating did not prevent nickel release, and that dimethylglyoxime-negative white gold (which they showed released nickel), caused dermatitis in highly sensitized persons after closed contact. "Hypoallergenic" studs that release less than 0.005 ug of nickel, however, have not been reported to cause nickel sensitization or symptoms in nickel-sensitive patients. Contact dermatitis induced by gold has also been described, but is rare due to the insolubility of gold in bodily secretions. The insertion of gold earrings into recently pierced ears greatly increases the chance of gold sensitization. When it occurs, the dermatitis tends to be prolonged, sometimes lasting several months, even though there is no further contact with gold. The following guidelines should help to prevent many of the complications of ear piercing: 1. Use a surgical grade, stainless steel, one-piece earring with an interlocking groove (such as those manufactured by Roman Research (Hanson, MA) along with a spring-loaded ear piercing instrument. 2. If a sterile needle is used to pierce the ear, be certain that the earring inserted afterwards is completely nickel-free. 3. Avoid gold-plated or gold alloy earrings for at least six weeks after ear piercing. Always ask for earrings that are nickel-free. (inexpensive, sterling silver, yellow gold, gold or silver-plated, and even 14 karat or 18 karat gold earrings often contain nickel, which commonly causes allergic rashes.) 4. Remember that "hypoallergenic" does not necessarily mean that the earrings are nickel-free. If in doubt, you can test the earrings yourself for the presence of nickel with a dimethylglyoxime test kit. Synopsis: Complete report available upon request.