I had my upper ear cartilage pierced one year ago. Several months later, the upper ear developed an infection that my regular doctor treated with antibiotics and a mild steroid. There was some improvement, but it has not healed as it should. My doctor sent me to a dermatologist, who performed a biopsy on the cartilage (results in a few days) and prescribed more antibiotics. The upper ear is extremely swollen and very sore. Why not cut it open and clean it out? I would appreciate any information you could give me about this.

C.C.

The condition you describe is most likely "chronic perichondritis," an inflammation (and possible chronic infection) of the perichondrium. Perichondrium (the word literally means "next to cartilage") is a tough tissue that envelops the ear cartilage. Cartilage is an interesting tissue. It has no independent blood supply, but must take its blood supply from the perichondrium. Thus, if the perichondrium is injured, the cartilage is at risk of dying due to a lack of oxygen and nutrition.

The inflammation you describe ("the upper ear is extremely swollen and very sore") suggests that your immune system is in high gear. There are two possible explanations for this: active infection and/or the presence of dead tissue. (It is quite possible that both problems are present.) Dead tissue is a potent trigger to activate the body's immune system. Your body wants to "mop up the debris" -- get rid of the dead stuff, in other words. With regard to chronic infection, your immune system is trying to kill any bacteria that are present and, once again, mop up the debris.

Funny thing about the immune system: It can't seem to do anything without causing at least a little collateral damage -- i.e., damage to healthy tissue. Thus, occasionally, the immune system becomes part of the problem. That's why your first doctor placed you on a mild steroid; steroids are anti-inflammatory drugs.

Your dermatologist's decision to biopsy the ear cartilage was a calculated risk. On the one hand, a biopsy will cause further damage to the cartilage, leading to even more inflammation. On the other hand, it would be extremely helpful to know more about the inflammation, since this could guide further treatment. For example, if the biopsy demonstrates chronic infection, a prolonged course of antibiotics may be curative. If there is no infection, your dermatologist may decide that a long course of antibiotics is unnecessary and unduly risky. (Antibiotic therapy is not without risk.) Similarly, certain biopsy results would suggest that a more aggressive course of steroids is required.

Why not cut it open and clean it out? I wish life were that simple. There are certainly instances where this is the right thing to do (after all, that's how we treat abscesses), but in your case, there's a good chance that your surgeon would only cause further injury, in turn provoking even more inflammation. More inflammation, more collateral damage.

Now for my soapbox. PIERCING THROUGH CARTILAGE IS A BAAAAD IDEA, as you have just discovered. Skin piercings heal quite well; skin grows inward, and you usually end up with a skin-lined hole. The typical earlobe piercing can be complicated by chronic infection, too, but this generally resolves once the earring is removed. Cartilage, on the other hand, does not fare quite as well. If you are lucky, skin will grow inward, protecting the exposed cartilage. Until that happens, you have a raw surface of cartilage -- damaged cartilage, since you have just thrust a sharp object through it -- right next to a foreign body (the earring). You also have a nearby source of bacteria. (Skin is rife with bacteria, after all.) This is an ideal setup for chronic infection.

The fact that this problem does not occur more frequently is, I think, a tribute to the human body's ability to heal, no matter what we do to it.