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From: Anne Greenblatt <[e-mail]>
Newsgroups: rec.arts.bodyart,news.answers,rec.answers
Subject: rec.arts.bodyart: Piercing FAQ 6--The Healing Process & Healing Problems
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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