Ask Angel

Dealing with “Localized Piercing Pimples”

Below is the information I give to clients who have that type of ugly bump that looks like a zit right next to a piercing? This is how I was taught to deal with them and I wanted your opinion.

A follicular cyst occurs when a foreign object is trapped inside your piercing. This could be a fiber from a q-tip, a hair, or a bit of dirt. When a follicular cyst occurs, you will see a bubble on the side of your piercing. This will go through cycles of filling with fluid, popping and draining, nearly healing, then starting over again. It will continue to do this until the irritant is removed.

This treatment will help eject the foreign irritant and help your piercing heal. Begin when the bump is at the height of its cycle, filled with fluid. Treat twice a day for 5 days.

• Sea salt soak: Mix 1/4 teaspoon of sea salt per cup of boiled water. Let cool. Soak your piercing for 5 minutes, then rinse.
• Polysporin cream: Cover piercing in a dollop of the cream, not ointment! Ointment is petroleum based and can harbor bacteria.
• Hot compress: For 5 minutes while cream is on, with water as hot as you can stand.
• Pop it: Burst it and drain as much of the fluid out as you can.
• Soap: Wash with anti-bacterial liquid soap like Dial. Rinse and pat dry.
• Peroxide: One Drop Only! Normally peroxide is strongly discouraged for piercings, but in this case, it will help to dry it out and pull out the fluid built up inside.

Should I change anything?
Thank you,

Dear R.,

The truth is that your suggestions need some extensive revisions:

The term “follicular cyst” is a misnomer, as those occur in the ovaries. Based on its appearance, I labeled this type of bump the “localized piercing pimple,” since the doctors I polled could not reach a consensus on the diagnosis. This complication has symptoms like those of folliculitis, which is probably how the name got started down the wrong path. Folliculitis is an inflammation in or near a hair follicle—but piercing pimples can occur in the nipple where these follicles are not present.
It is inaccurate to attribute the piercing pimple to a “trapped foreign object.” The pustule (small round area of inflamed skin filled with pus) is located adjacent to the piercing channel, rather than within the wound bed itself. It appears that this problem occurs in the absence of a foreign body (other than the jewelry). The issue is most likely caused by trauma or a mild infection that remains contained. Unfortunately, the whole premise of your approach is erroneous.

Note that piercers are prohibited by law from diagnosing or treating any medical conditions. You could call your sheet “Troubleshooting Guidelines” or something similar, and since “localized piercing pimple” is not a recognized medical problem, you should be fine utilizing that terminology.

Your advice for twice-daily use of saline and Polysporin® plus soap and peroxide is apt to cause excessive irritation in some piercees. Applying such strong products will suspend healing, and could cause a secondary complication such as contact dermatitis. I’d suggest you drop the directive to apply peroxide since it is known to kill off healthy cells , and there is no foreign object to expel. Further, Dial® is a very harsh product that has never been suited for use on piercings. Now Dial® and other consumer soaps containing Triclosan and eighteen other anti-bacterial ingredients are being pulled off the market (or reformulated).

Actively popping a pustule can result in the spread of infection. Clients should not be advised to do anything so invasive, especially in writing. Proposing those actions without any mention of hand washing and use of medical gloves makes it even worse. Nor should you agree to assist with popping a piercing pimple; that could also fall under practicing medicine without a license. If a piercee has a localized pustule that won’t drain after the application of moist heat (soaks or compresses) and needs to be lanced, you should direct him or her to seek medical assistance.

Having piercees apply compresses made with water “as hot as they can stand,” could result in severe burns on individuals with a high pain tolerance. A much safer guideline is that a compress should be the temperature of a “drinkable hot beverage.” It is not advisable to use cream in conjunction with hot compresses as this can further increase the heat and potentially cause burns.

I’m advocating the use of a natural spray containing a dilute solution of hypochlorous acid (HOCl .02%) in isotonic saline, and I have found it to be immeasurably superior for routine cleaning of piercings, and for troubleshooting problems. There is substantial scientific research proving its safety and effectiveness for wound healing. Additionally, it swiftly destroys far more pathogens than any soap without drying or irritating the skin.

Don’t forget to start with our traditional troubleshooting principles. First evaluate jewelry quality, style, and fit, plus appropriate placement to the individual anatomy. Also inquire about your clients’ lifestyle habits, (nutrition, hydration, sleep, and stress management). Then check to be sure they’re not doing anything unreasonably traumatic to their piercings. Following that, my advice would be:

• Spray on HOCl solution 4-6x daily (or wash once daily with mild liquid soap).
• Mild warm saline soaks and/or hot (not scorching) compresses 2x daily.
Important: continue soaks for two weeks after the bump seems to have gone away.
• Light localized massage can break up the pocket that fills with pus. This is one of the most effective ways to resolve the issue permanently. Massage with clean or gloved fingers 2x daily, after a soak or hot compress.
• Apply an over-the-counter antibiotic cream or gel according to package instructions.

See a doctor immediately if:

• The symptoms last for a week, spread to a wider area, or become severe.
• You experience a fever over 100 ̊F (37.8 ̊C), chills, nausea, vomiting, dizziness and/or disorientation.
• The piercing is very painful, swollen, has red streaks emanating from it, or there is a lot of pus discharge.

Don’t neglect to include a disclaimer: These suggestions are not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.

If a piercee does not respond to this approach, a doctor may need to order a lab analysis to identify the invading microorganism and prescribe medication to target the culprit. Applying an antibiotic won’t work if the problem is fungal.

Doctors who are unfamiliar with piercings may be unsure what to prescribe. You can inform healthcare professionals, or clients visiting them, a prescription-only antibiotic cream (not ointment) called Bactroban® or Mupirocin is recognized as an effective topical medication for bacterial infections, possibly including localized piercing pimples.

As piercers, and not licensed medical professionals, it is essential that we stay up to date with developments to provide accurate information that will help, not harm our clientele, while remaining within the boundaries of the law.

Elayne Angel