When an abnormal bump appears around a piercing, people frequently jump to the conclusion that they're developing a keloid scar. In actuality, though, keloids are one of the most uncommon types of body piercing scars. What piercing issues may appear to be scars that aren't? If a scar has formed around a current or retired piercing, what type of scar is it and how should you handle it? In this article, we dive into the most common piercing issues that are sometimes mistaken for scars, as well as the different types of scars that can form around piercings and how best to treat and prevent each one.
Bumps and scars are common complaints with piercings, particularly with piercings that are still healing. More often than not, though, piercing problems are simply due to temporary irritations—irritations that usually crop up in the early days of the piercing healing process as opposed to months or years later, which is more often the case with scars. If you've developed a nose piercing bump, a strange bubble around a belly button piercing, or any other odd lump around another body piercing, the first thing you have to do is rule out issues that can be addressed with increased and enhanced piercing aftercare.
After getting a new piercing, your piercer should have sent you home with a product like H2Ocean or Recovery Piercing Aftercare Spray. For many people, simply spraying their piercings with such saline rinses a few times a day is sufficient piercing aftercare. However, something as small as a microscopic granule of dirt or as major as an allergic reaction could have caused unusual swelling around your piercing or even hypergranulation that requires more in-depth care to clear up. Hypergranulation typically presents as a red bump ranging in appearance from a small, fluid-filled pustule to a larger red bump that looks similar to a keloid scar but that doesn't behave like one, as is the case with the hypergranulation issue shown in the image to the right. Hypergranulation is the most common problem associated with new piercings, and it's usually fairly easy to address.
If you think the red bump around your piercing may be a hypergranulation issue, the first thing you should do is change your jewelry to a length and/or style that doesn't put any pressure on your piercing. You may need a longer barbell, or you might consider switching to a captive bead ring, depending on your piercing. Tight-fitting jewelry and trapped moisture are often enough to trigger hypergranulation of a piercing, which is why getting the pressure off should be your first priority. While you're changing your jewelry, consider switching to a hypoallergenic material like BioPlast or a highly-inert metal like titanium. It's unlikely for a metal allergy to display as a red bump—it's a more likely culprit if you have an unusual amount of swelling and the skin around your piercing becomes itchy, red and/or tender--but wearing non-irritating, quality jewelry is never a bad move.
Once you have well-fitting, good-quality jewelry in your piercing, the next step in ridding yourself of a hypergranulation issue is to ramp up your piercing aftercare regime. You can supplement spritzes of piercing aftercare spray with full sea salt solution soaks, using either a store-bought saline rinse or homemade sea salt solution. To make your own solution, boil 1 cup of water for 5 minutes to sterilize it, or buy sterile water and measure out one cup. Stir in 1/4 teaspoon sea salt (aquarium salt from a pet store will work) until it's dissolved. If you're treating an external piercing problem, you may also want to add a few drops of tea tree oil to your solution. Tea tree oil is a natural antiseptic and moisturizer that promotes healing and healthy skin around piercings. It needs to be diluted in a carrier rather than directly applied, though, which is why it's an ideal sea salt solution enhancer when you're dealing with a piercing issue like hypergranulation or dry, cracked skin around a piercing.
You should do full sea salt solution soaks 2-3 times per day whenever you have an irritated piercing, and then supplement by applying a piercing aftercare spray in between (i.e. morning, noon, night, and any other time your piercing begins to feel hot and dry). To do a full soak, either saturate a fresh cotton ball with store-bought saline rinse or soak it in homemade sea salt solution, and then press the wet cotton ball gently against your piercing. You'll need to keep soaking your piercing for 5 minutes per session, using a series of clean, saturated cotton balls to get the front and back of your piercing or just to keep applying fresh solution to a single point (one-sided) piercing like a dermal. For belly piercings and nipple piercings, you can fill a small container like a shot glass with sea salt solution, lean forward until the cup is pressed against the skin around your piercing, sit upright again, and hold the glass in place for 5 minutes. Some other piercings, like earlobe and genital piercings, can also easily be fully submerged in sea salt solution.
You should begin to see an improvement in the external appearance of your piercing within a few days to a week of changing your jewelry and ramping up your aftercare regime. You'll see the fastest improvement if you're also getting plenty of rest, eating nutritiously, being hygienic overall, and generally taking good care of yourself. If the bump around your piercing hasn't shown signs of improvement within 1-2 weeks, then you may actually have progressed from an irritation to a full-blown infection requiring antibiotics or have a more permanent problem, like a scar.
All scars are the result of fibrous tissue replacing normal tissue after a piercing, an injury or surgery. There are two primary types of scars that may develop around new or retired piercings and a third type that's more likely to develop where retired piercings once were: hypertrophic scars, keloid scars, and atrophic scars.
Hypertrophic scars and keloid scars are both the result of excessive collagen growth that overextends the normal, healthy tissue around them, whereas atrophic scars are sunken scars comprised of collagen growths that leave an indentation instead of a raised bump or series of bumps, as is often the case with keloids. As mentioned earlier, keloids are very uncommon despite the fact that they're often people's first concern when they develop a bump or lumpy tissue around a piercing. Keloid scars are typically hereditary, and if you're prone to keloid scarring, you'll likely know well before you ever get a piercing. Anyone may develop hypertrophic scars around new or retired piercings, or atrophic scars where retired piercings once were.
Keloids typically manifest as reddish-brown, bulbous, taut/smooth-surfaced bumps that begin around a piercing and often continue growing outward, well beyond the piercing hole. That type of rampantly excessive tissue growth is what characterizes keloid scars. The image to the left shows a relatively minor keloid scar that formed around someone's earlobe piercing. Without early treatment, that keloid may have continued to grow until the person's entire earlobe was covered up by it.
As with all scars, keloids are the result of an accumulation of collagen in and around a piercing or other wound. However, genetics adds fuel to the fire and triggers a person's scar tissue to grow out of control, forming a bulbous keloid. If you're prone to keloids, getting any body piercing is risky business. If you've never been known to develop keloids and no one in your family is prone to them either, then it's highly unlikely that the bump around your piercing is a keloid scar.
Hypertrophic scars are much more common than keloids. They're typically flesh-colored (or just slightly-redder-than-flesh-tone initially) and are most likely to form closely around a piercing hole, sometimes in an almost perfect circle with a fairly flat, roughly-textured top. (The photo to the right shows a hypertrophic, or raised, scar that formed along a torn earlobe piercing.) Both hypertrophic scars and atrophic scars tend to form within 4-8 weeks after getting or retiring a piercing. When a hypertrophic scar develops, changes in jewelry and piercing aftercare will have little to no impact on the scar tissue. Eliminating, or at least shrinking, a hypertrophic scar may require more than a simple jewelry change or ramped up aftercare regime, but it doesn't necessarily require professional medical intervention like a keloid would.
Unlike keloids, which tend to extend well beyond a piercing or wound site, and hypertrophic scars, which are raised but form more closely around a wound site than keloids do, atrophic scars are the result of more minimal bundles of collagen partially filling in the void of tissue where a wound or piercing was. The end result is a sunken recess in the skin that has a pitted appearance. For instance, if you've retired a labret piercing and now have a small, indented scar on your lower lip like the girl in the photo to the left, or you've had a dermal anchor removed and scar tissue has mostly filled the hole where the dermal was but left an indentation, you're dealing with an atrophic scar. Since both atrophic scars and hypertrophic scars are due to the same type of collagen overproduction, just in varying amounts, the same scar therapies tend to help minimize both types of scars by allowing healthy tissue to replace the lumpy collagen growths that comprise scars.
Treating Body Piercing Scars
Once you're sure that your piercing problem is in fact a scar rather than a hypergranulation issue or allergy, you can tackle the problem head-on. In the case of a new piercing, simply removing your jewelry is unlikely to eliminate scarring, so don't feel pressured to retire your piercing. If you have a small scar where you used to have a piercing, the course of treatment will generally be the same unless you're dealing with a keloid scar in the early phases of development.
For those few who do develop keloid scars around piercings, it's best to see a dermatologist. S/he will be able to offer a variety of treatments that you just can't replicate at home, like laser therapy to reduce the scar tissue, injection of corticosteroids to minimize inflammation (shown in the image to the right), freezing the tissue to kill overactive skin cells, using radiation to shrink the keloid, or even surgically removing the scar tissue. You may also need to supplement your outpatient keloid scar therapy by applying moisturizing oils like jojoba oil at home to keep your skin soft and supple as it heals. Talk to your doctor and see which combination of these treatment options s/he recommends for you. If you have any concerns about your dermatologist's recommendations, talk to him or her about it or seek a second opinion.
Treating Hypertrophic & Atrophic Scars
Treating an atrophic or hypertrophic scar is usually much easier than treating keloids. Although a dermatologist should be able to help you with any type of scar, treatment of hypertrophic and atrophic scars can often be done at home for minimal cost and just a few minutes of daily attention. If you've developed an atrophic or hypertrophic scar around a relatively new piercing, though, it's important to wait until your piercing is fully healed to begin treating the scar tissue. Applying any ointments to a healing piercing can clog the fistula (piercing hole), potentially trapping in bacteria and/or debris and leading to infection.
Dealing With Infection
If you start treating your atrophic or hypertrophic scar too soon after getting pierced and you develop infection-related symptoms like red streaks radiating from your piercing, skin that's hot to the touch, and/or discharge of thick, yellowish pus, discontinue use of your scar treatment immediately. You should also ramp up your aftercare regime in the manner described under "Hypergranulation" above until the infection clears. If your symptoms persist or get worse, visit your family physician right away to see if you need an antibiotic. Don't worry if your doctor tells you that you should remove your jewelry and let your piercing close, because you shouldn't have to do that as long as you continue practicing vigilant aftercare while taking your antibiotic. In fact, it's best not to let a fistula close up while there's still infection trapped inside; keeping your jewelry in will allow your piercing to drain as needed as the infection clears up.
Currently, one of the best treatments for atrophic and hypertrophic piercing scars is silicone gel that you can apply at home yourself on a daily basis until you're satisfied with the diminishment of your scar. There are a variety of silicone-based scar treatment therapies available at most drug stores, and Painful Pleasures will be adding silicone scar therapy gel to our line of Recovery Piercing Aftercare products soon, too.
Most silicone scar treatments simply require massaging a small amount of silicone gel into a scar twice a day until you're satisfied with your progress, which may take anywhere from a few weeks to several months or more. These treatments work by slowly reopening cell communication that the scar tissue previously blocked so that the skin below a scar regenerates in the same way as the skin around the scar, replacing the scar tissue layer by layer over time. You can read more about the benefits of silicone gel for minimizing scar tissue in our blog post, Is Silicone Gel Effective for Treating Piercing Scars? (And the answer is yes, it is! Read the blog post for information about studies that prove it, statistics on silicone gel's efficacy, and other related information.)
If you'd rather try a more natural treatment option before using a silicone scar therapy gel on your atrophic or hypertrophic scar, consider using jojoba oil instead. Massage a small amount of jojoba oil into the skin around your piercing twice a day for as many weeks or months as it takes to diminish your scar satisfactorily. Jojoba oil is a natural moisturizer, and it's also known to reduce scar tissue when applied regularly over time. It works much the same way as silicone gel, but positive results may take longer to achieve than with silicone gel.
You can also see a dermatologist and have him or her remove a hypertrophic scar surgically or provide another speedier form of scar therapy. The only downside to cutting away a hypertrophic scar is that more scar tissue may form in its place, possibly covering a larger area than the original scar did or leaving a pitted, recessed atrophic scar behind. Silicone gel and jojoba oil may take months to minimize a scar sufficiently, but they're non-invasive and have fewer potential negative repercussions than surgery.
How to Prevent Piercing Scars
One of the primary reasons piercers encourage people to attend so carefully to their new piercings is to ensure that the piercings heal well and with minimal-to-no scarring. When any wound stays open too long, either because of negligence or due to the severity of the wound, you're at greater risk for scarring. However, if a piercing or any other wound is covered by epithelial tissue within two weeks, the body will deposit a minimal amount of collagen at the wound site, preventing scarring. Epithelial tissue is specialized type of protective tissue that covers the entire surface of the body and the lining/covering of all internal body surfaces, too.
By keeping your new piercing as clean as possible with an appropriate, gentle cleanser like saline wash/sea salt solution, you'll help that first, all-important layer of protective epithelial tissue to re-form as quickly as possible. Once formed, the layer(s) of epithelial tissue will promote healthy tissue growth below the skin's surface and prevent scar tissue growth. Taking steps to ensure that a new piercing heals fully and well will also make you less likely to develop an atrophic scar later, if/when you remove your piercing.
For additional tips on how best to care for your new piercing in order to prevent scarring, read our Body Piercing Aftercare article.
Cosmetic Procedures: Scars Webmd.com Article
Keloids and Hypertrophic Scars American Osteopathic College of Dermatology Article
Epithelial Tissue Article on Botany.uwc.ac.za