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Subject: rec.arts.bodyart: Piercing FAQ 6--The Healing Process & Healing Problems

This article was archived around: Tue, 02 May 2000 07:20:47 GMT

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Archive-name: bodyart/piercing-faq/healing-process-problems Last-modified: May 01, 2000 Posting-frequency: Quarterly URL: http://www.cs.uu.nl/wais/html/na-dir/bodyart/piercing-faq/.html
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 30 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 9A--Resource List 9B--Resource List Cont'd 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 6.2 Abandoning a Piercing 6.2a Reopening or Repiercing an Abandoned Piercing 6.2 Healing Problems 6.2a Dry Skin 6.2b Prolonged Healing 6.2c Follicular Cysts 6.2d Infections 6.2e Hypergranulation 6.4 Scars 6.6 Piercing Migration and Rejection 6.7 Metal Sensitivities All texts written and (c) 2000 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. 6 THE HEALING PROCESS & HEALING PROBLEMS Finding a piercing-knowledgeable doctor is more difficult than finding a doctor that is piercing-friendly. 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 placement, or a metal sensitivity. Doctors often 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 because they think the doctor may disapprove. Your doctor should be professional and should not be morally judgmental or express personal disapproval about your piercings. 6.1 THE HEALING PROCESS General Wound Healing Process The wound healing process is comprised of three overlapping phases: inflammation, proliferation, and maturation. During the inflammatory phase, blood vessels contract and red blood cells clot the wound while white blood cells collect in the wound to fight infection. During the proliferative phase, special skin cells migrate into the wound beneath the crust (scab) and grow. Granulation tissue fills the wound and new capillaries form, giving the tissue its red color and granular texture. The wound begins to contract and the granulation tissue is soon covered with a layer of epithelial tissue (new skin cells). During the maturation phase, also known as the remodelling phase, new collagen is formed to create a scar. The wound slowly regains strength as the scar reaches its final size and shape. Scar maturation usually takes at least a year. A scar is only about 80% as strong as the original skin. Piercing Healing Process During the inflammatory phase, the area surrounding the piercing will be slightly red, swollen, and may feel warm to the touch. These symtoms should not worsen and should last no longer than a week. Unlike a wound such as a scratch or cut, a piercing cannot heal across tissue layers. A piercing can be thought of as a tunnel whose entire inner surface must heal. If the body is unable reject a foreign object, in this case the jewelry, it begins the healing process in order to create a barrier against the foreign object. Because the environment within the piercing is moist, the piercing cannot form a crust. The piercing will produce an exudate (discharge) of lymph and dead cells. The discharge is white to off-white in color and dries to a yellow crusty formation around the openings of the piercing and on the jewelry. As the epithelial layer forms the piercing may constrict around the jewelry. The epithelial layer can easily be torn or dislodged; do not force the jewelry to rotate. The piercing may need to be soaked in warm water to allow the skin to expand so that the jewelry can be rotated. Once the final layers of skin cells form within the piercing, they must toughen and strengthen. This process often requires 6 months to a year. As the piercing becomes more cohesive the entrances will round inwards, like a donut hole, and the piercing will become more flexible and relaxed around the jewelry. The tissue surrounding the piercing will soften. If you plan to keep your piercing do not remove your jewelry for any length of time while it is healing. If changing the jewelry is necessary the change must be continuous to prevent the piercing from shrinking or closing. Please refer to Part 7 of the Piercing FAQ for information about changing jewelry. Most body piercings require at least 6 months to a year before the jewelry can be removed for any length of time without the risk of the piercing growing closed. After the piercing has toughened it will not close but will often shrink, in which case the piercing must be stretched using an insertion taper to reinsert the jewelry. 6.2 ABANDONING A PIERCING Whether or not the piercing completely closes depends on the age of the piercing and the gauge of the piercing. Older piercings, particularly those that have been stretched, will shrink but usually will not close. If the piercing does not close it will collect dead skin cells and dirt. 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. Scarring is usually minimal. Continue to clean your piercing until it closes. Soaking the piercing is beneficial in drawing-out discharge. 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 often result. The interior of the piercing may be felt as a knot or raised line under the skin which usually shrinks and softens over time. 6.2a Reopening or Repiercing an Abandoned Piercing An abandoned piercing that has only shrunk or partially grown closed can often be reopened using an insertion taper, even if the piercing appears to be lost upon visual inspection. Reopening a shrunken or partially closed piercing is far less traumatic and will take far less time to heal than repiercing. An abandoned piercing that has grown closed may be repierced after the scar tissue has matured and softened, a process which may take a year or more. However, since the skin will never be as strong as it was originally, repiercing behind scar tissue will not insure a successful piercing. 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 very painful. 6.2 HEALING PROBLEMS 6.2a Dry Skin Over-cleaning the piercing, failure to thoroughly rinse the piercing after using a skin cleanser or soap, or using a skin cleanser or soap that is too drying can cause the openings of the piercing to become red, overly dry or cracked. Most piercings do not require cleaning more often than 2 or 3 times a day. A light, greaseless moisturizer or aloe vera gel may be applied to the skin surrounding the piercing, but should not be allowed into the piercing. Please refer to Part 5 of the Piercing FAQ for information about aftercare products. Sensitivity to the aftercare product is usually indicated by extreme itching and burning upon application of the product and may cause a rash of small bumps around the piercing. If you suspect that you are allergic to a particular product, discontinue its use, thoroughly irrigate the piercing, and rinse the affected area with water. Consult your piercer or refer to Part 5 of the FAQ for alternative aftercare products. If the condition persists contact a physician. Some people have noticed that the condition of their piercings deteriorates or that the healing process is slowed when they move 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 to wash clothing which is in direct contact with the piercing. 6.2b Prolonged Healing Prolonged healing is indicated by failure of the piercing to complete the final stages of healing. The epithelial layer may be weak and easily dislodged and the entrances of the piercing often remain ragged. If severely irritated, the area surrounding the piercing may be red and swollen. The most frequent causes of prolonged healing include: - placing the piercing at an inappropriate depth or angle to the tissue - piercing in an area that changes shape with body movements - wearing jewelry of inappropriate design or dimensions (gauge, width, length) - wearing jewelry that is scratched or underpolished - friction or pressure against clothing / other body parts / other jewelry - injury to the piercing - chemical irritation or using an inappropriate aftercare product A darkening of the skin between the entrances indicates that the piercing is constricted by the jewelry. The jewelry may be too small in diameter or length or too thick in gauge, or the piercing was placed too deeply or at an inappropriate angle to the tissue. Prolonged healing may indicate migration or rejection (refer to section 6.4) or a metal sensitivity (refer to section 6.5). 6.2c Follicular Cysts Follicular cysts may affect both new and healed piercings. They are caused by a blocked pore adjacent to the piercing. Follicular cysts often appear as red bumps, or pimples, adjacent to the entrance of the piercing and will produce a discharge of pus and blood. Hot compresses or soaking the piercing in hot salt water will encourage the cyst to drain. Hydrogen peroxide gel can be used to dry-out follicular cysts. 6.2d 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. Any infection should be treated seriously. Symptoms of infection may include a discharge of yellow or green pus, pain, redness, swelling, and the area will feel hot to the touch. Infected piercings often bleed. If the piercing is draining pus, do not remove the jewelry. If the jewelry is removed, the openings of the piercing will close and the infection will not be able to drain, which can result in an abscess. An abscess is an infection that is trapped under the skin. An abscess is indicated by a darkening and hardening of the surrounding tissue, swelling, and pain. Cartilage piercings are particularly prone to abscesses because of the different layers of tissue involved. Occasionally an abscess will form even if the jewelry is left in place, particularly if the piercing is extremely swollen and constricting around the jewelry. In this case switching to thinner gauge jewelry may allow the piercing to drain. An abscess usually requires treatment with oral antibiotics and may require excision (surgical removal). An infection may cause nearby lymph noes to swell and become tender. An infection that does not clear within two to three days or an abscess should be seen by a doctor. Hot compresses or soaking the piercing in hot salt water will encourage the infection to drain and increase blood circulation to the piercing. Use 1/4 teaspoon sea salt or table salt to 8 ounces of water. Epsom salt (hydrated magnesium sulfate) is not the same chemical composition as sea salt or table salt (sodium chloride) and should not be used. 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 should be used 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. Compresses should be made of clean disposable materials such as cotton balls or gauze sponges; compresses can be reheated in a microwave oven. Please see section 5.8 for an herbal compress recipe. Hydrogen peroxide is sometimes helpful in draining pus and debriding an infected piercing. Hydrogen peroxide should not be used for daily piercing aftercare. Some people use over-the-counter antibiotic ointments to treat mild infections. However, these products are not intended for puncture wounds, prolonged use, or existing infections. If untreated, a localized infection can quickly develop into cellulitis or a systemic infection. Symptoms of cellulitis include red streaks on the skin, swollen lymph-nodes, fever and chills. The area surrounding the piercing will be extremely red, inflamed, swollen, and painful, and the skin may develop an orange peel-like texture. 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. 6.2e Hypergranulation During the proliferation phase of healing, granulation tissue forms along the inner surface of the piercing. Occasionally a piercing will develop excess granulation tissue, a condition described as hypergranulation. Excess granulation tissue is red or dark pink and often forms a raw-looking, visibly layered bump that appears to erupt from the entrance(s). Capillaries will grow into the tissue, and hence the tissue will often bleed when disturbed. This condition is usually not painful, but the piercing may be more susceptible to infection. Hypergranulation prevents epithelialization and the healing process is arrested. While hypergranulation can affect any piercing, piercings in moist areas which are also subject to prolonged physical irritation appear to be particularly vulnerable. Prolonged physical irritation or pressure exerted on the piercing may push the granulation tissue out of the piercing where it continues to form. Removing the source of irritation and keeping the piercing dry will often allow the piercing to heal correctly. Because granulation tissue is very delicate, it can sometimes be removed by wiping with a cotton swab or gauze sponge. Excess tissue may also be excised. However, in some cases the condition often persists and excess tissue will continue to form. If hypergranulation is persistent, the piercing may have to be abandoned. The most common method of removing excess granulation tissue is chemical cautery with silver nitrate. When silver nitrate contacts the tissue, the tissue dies almost immediately and may be wiped away. Most physicians encourage patients to remove their jewelry (and abandon their piercing) to ensure successful treatment. 6.3 SCARS Any penetration of the skin will result in a scar. Scar tissue is comprised of collagen produced during the latter stages of wound healing. Excessive scarring at the entrances of a piercing can result in an unattractive or uncomfortable piercing. Many people erroneously assume all bumps or swellings to be keloids. Scar tissue does not bleed or produce discharge or pus. Pus indicates an infection. Please refer to section 6.2. Keloids are hard, raised, bulky formations of scar tissue under the skin's surface which spreads beyond the boundaries of the wound. Keloids can become progressively larger and can be painful. The tendency towards developing keloids is often hereditary and is more common in people with dark complexions. True keloids are very difficult to treat. Hypertrophic scars tend to be fleshy and stay within the boundaries of the wound. Affected piercings may appear to have protrusions of soft pink skin at the entrances. In some cases hypertrophic scar tissue is reabsorbed as the piercing heals or when the source of irritation is eliminated. Hypertrophic scars are more common in people with fair complexions. Methods of Treating Scars Attempting to treat excessive scar tissue around a piercing without evaluating and eliminating the cause of irritation often does not succeed over the longterm. Once a scar begins to form, the jewelry will continue to irritate the area and the scar will continue to grow. Removing the jewelry and allowing the piercing to close is often the only remedy if the scar continues to grow. Sources of irritation that can cause excessive scar tissue around a piercing include: - placing the piercing at an inappropriate depth or angle to the tissue - piercing in an area that changes shape with body movements - friction or pressure against clothing / other body parts / other jewelry - wearing jewelry of inappropriate design or dimensions (gauge, width, length) - injury to the piercing - stretching the piercing too fast or too soon A line- or dimple-shaped scar behind or above the piercing usually indicates that the piercing is migrating. Please see section 6.4. Heavy keloid or hypertrophic scar tissue is sometimes treated with injections of steroids. The steroids act to shrink the scar by breaking down the collagen in ther scar. While steroid injections with the jewelry in place may help shrink the scar, the jewelry will continue to irritate the area and the scar will continue to grow. Steroid injections do not work well in cartilage layers. Hypertrophic scars can be treated successfully with scar revision - various surgical techniques to change the shape or size of the scar or replace the scar with a smaller one. Keloid scars usually do not respond to revision. A relatively new method of treating scars is silicone gel sheets. Several brands are available through skin care and medical suppliers. Silicone gel sheets seems to be effective on hypertrophic scars and may help some keloid scars. Silicone gel sheets can only be used in flat areas where the sheet will adhere to the skin; therefore it cannot be used on a piercing with the jewelry in place. Over-the-counter hydrocortisone ointments and creams containing from 0.5% to 1% cortisone can sometimes be used to shrink 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. Vitamin E, applied during healing, may minimize the size of the scar that forms. Some people are allergic to Vitamin E; an allergy is indicated by a rash of small bumps. Some people have successfully treated hypertrophic scar tissue using hydrogen peroxide gel or solution. However, hydrogen peroxide can impede healing with prolonged use. Some people have successfully treated scar tissue on oral piercings using an aspirin and water paste. This method is not suggested; aspirin can easily damage delicate oral tissues. 6.4 PIERCING MIGRATION AND REJECTION Occasionally a piercing migrates towards the surface of the skin or rejects (grows-out). Migration and rejection is indicated by the piercing becoming narrower and more shallow, and the jewelry may become visible through the skin. A scar or a dimple often forms where the piercing was originally placed. A piercing which is quickly rejecting will form scabs where the piercing was originally placed. Healing will be prolonged; the entrances of the piercing will remain red and ragged. Frequent causes of migration and rejection include: - attempting a piercing where not enough tissue is available to support the piercing - placing the piercing at an inappropriate depth or angle to the tissue - wearing jewelry of inappropriate design or dimensions (gauge, width, length, weight) - friction or pressure against clothing, other body parts, or other jewelry - injury to the piercing A piercing should not be attempted if not enough tissue is available to support the piercing. Because everyone is built differently, not everyone is anatomically suited for every piercing. Piercings made in flat areas and areas which change shape during body movements often 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 tension between the jewelry and the tissue. A piercing should not be made excessively deep on the assumption that it will "migrate into place." Wearing jewelry of inappropriate design or dimensions often results in migration or rejection. A ring which is too small in diameter will constrict the piercing and cause the entrances of the piercing to migrate to relieve pressure and conform to the 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 which is too thin in gauge is more easily rejected. Wearing jewelry which is too thin increases the risk of the piercing being torn if the jewelry is suddenly pulled. However, the gauge must not be so thick that the strength of the tissue is compromised. Injury to the piercing can result in tearing or detachment of the epithelial layer lining the interior of the piercing. The epithelial layer can be torn if the jewelry is sharply pulled or if the jewelry is forced to rotate when the piercing has constricted around it. Often the piercing must be soaked in warm water to allow the tissue to expand before 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 examined for rough, underpolished areas or scratches. Jewelry that is underpolished or scratched will easily adhere to the epithelial layer. A rejected piercing may be repierced after the scar tissue has matured and softened, a process which may take a year or more. However, since the skin will never be as strong as it was originally, repiercing behind scar tissue will not insure a successful piercing. 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 very painful. 6.5 METAL SENSITIVITIES The metals used for body jewelry are chosen for their bio-compatibility, or "body friendly" quality. However, some metals are more bio-compatible than others due to their specific compositions, or alloys. The metals to which people are most often sensitive are nickel, copper, and chromium. Many metal sensitivities can be attributed specifically to nickel sensitivity. 316L / 316LVM stainless steel is comprised of several metals including nickel. However, the specific composition of 316L / 316LVM allows for very little exposure to the nickel molecules, thus reducing the risk of sensitivity. Some people are sensitive to the metals present in karat gold, namely nickel, silver, zinc and copper. White gold often causes more adverse reactions than yellow gold because a high amount of nickel is used to yield the white color. Many body jewelry manufacturers now use nickel-free gold alloys. White gold alloyed with palladium, an inert metal of the platinum group, instead of nickel is less likely to cause a metal sensitivity. Some people who cannot wear steel alloys can wear 18k white gold palladium alloys. People who are sensitive to stainless steel and gold alloys can often wear niobium or titanium without an adverse reaction. Sensitivities to niobium are rare but not unheard of; in some cases the "sensitivity" is actually an adverse reaction caused by the quality of the finish and not by the metal itself. Symptoms A metal sensitivity is indicated 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. In some cases a metal sensitivity is acquired after prolonged exposure. An extreme metal sensitivity often causes rapid rejection of the jewelry which usually manifests immediately. The piercing will enlarge or gape around the jewelry as the body tries to eject the jewelry. Other symptoms may include increasing redness and inflammation, itching, and a colorless discharge. The piercing may be saved by switching to a more biocompatible metal. A sensitivity to aftercare product(s) can exhibit similar symptoms. Please refer to section 6.2. A less extreme metal sensitivity can cause prolonged healing. Because prolonged healing can be caused by other factors, 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 appear to only experience metal sensitivity-related prolonged healing with piercings which usually require several months to heal. Some people who are extremely sensitive to metals have worn monofilament nylon or teflon to heal their piercing. However, jewelry made of monofilament is not appropriate for all piercings. 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 Health Gate http://www.healthgate.com/ -- -- Anne Greenblatt Manager of the rec.arts.bodyart Piercing FAQ Piercing Exquisite http://www.piercingexquisite.com