Brief: This page discusses a type of piercing bump known as Hypertrophic scarring. It is a very common piercing sport or lump and can be quite stubborn to remove. It is often mistaken for Keloiding.
TL;DR – Too much information? For a shorter version try our quick reference guide here.
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Hypertrophic Scarring is perhaps the most common bump that appears on body piercings. These bumps appear frequently on cartilage such as in the upper and inner ear and the nostril. These bumps are often mistaken for keloid scars but keloids are more permanent than hypertrophic scarring, which can actually heal by itself when given time.
A hypertrophic scar is a pink or purple-red bump which can also appear skin coloured and even change colour over time. The bumps are often quite itchy and can be prone to a peeling of the skin on and around the lump. Hypertrophic scars also tend to stay fairly close to the wound and tend to be quite solid to the touch like a pimple (although in rare cases they can feel ‘doughy’ and soft). They sometimes tend to follow the curve of jewellery in a body piercing.
A hypertrophic scar is created by an overgrowth of granulation tissue cells or proteins while a piercing is healing. Granulation tissue is the delicate new tissue that forms very soon after being pierced as a sort of ‘emergency patch’ which covers the wound and creates a network of blood vessels that brings healing cells and oxygen straight to where they need to be.
The over production of granulation tissue is thought to occur because it takes a delicate balance between cells breaking down to provide energy (catabolic phase) and the energy is used to build new cells (anabolic phase). When this process is disrupted more granulation tissue is produced than can be broken down or reabsorbed and so it grows in all directions, rather than just where it is needed, which is what forms the hypertrophic scar.
The reason for this over-production is due to uncontrolled signals from the wound cells which call forth more tissue cells than are needed, causing the imbalance, and more tissue than wanted. This imbalance is thought to be caused by increased or sustained inflammation (swelling) which stimulate collagen (tissue) production and granulation tissue placement.
Keloids and hypertrophic scars are actually created in the same way, which is why they are so similar when they are small. It is on the microscopic level where they really differ as they contain different types of collagen, perhaps due to a different layout of a growth protein (TGF-β3). Hypertrophic scarring generally occurs 4-8weeks after infection or trauma, grows for up to 6 months and then naturally starts to regress (go away) by itself. It can take several years for a hypertrophic scar to regress naturally, and they do not always do so completely, but they are not as ‘permanent’ as keloid scars.
Hypertrophic scars are often referred to (in medical terms) as a ‘pathological cutaneous scar‘ which is simply a scar on the skin that isn’t ‘normal’.
Here we discuss several different methods of preventing hypertrophic scarring. However if you have suffered a lot with them in the past it may be worth considering whether having a piercing is worth the risk. Hypertrophic scars are much more common on wounds which heal by secondary intention (Stay open as they heal) and wounds that have foreign bodies in them, which is essentially what a piercing is. There is also no sure way to prevent them from occurring.
Pressure Therapy. Pressure therapy is thought to prevent hypertrophic scarring but not for the value of pressure itself (as there would need to constant pressure to make a difference). Instead it is thought that compression helps to gently press back into place the membrane that ‘feeds’ cartilage which could help prevent hypertrophic scarring by giving healing cells a clean pathway to the wound.
Prevent Trauma. Accidentally knocking the piercing can also cause hypertrophic scarring to appear. Damage to the healing tissue can cause parts of the healing process to restart, allowing more tissue to form and giving the piercing the potential for the overproduction of tissue. So being careful around the piercing can really help.
Look after your body. It is also thought that abnormal healing like hypertrophic scarring happens in wounds due to a lack of certain nutrients.
- In particular essential fatty acids such as omega 3 (Linoleic and Eicosapentaenoic acid in particular) have been shown to effect wound healing so a cod liver oil supplement could be helpful.
- Omega 6 has been detected within hypertrophic scarring and is believed to be what helps to form and maintain it so eating less polyunsaturated (‘bad’) fats could also be beneficial. Omega 3 supplements like cod liver oil or enriched butter spreads also help to balance out omega 6.
- A lack of vitamin A, C and the mineral zinc can also cause problems when healing a wound so a multivitamin may also prevent abnormal healing patterns like hypertrophic scarring from occurring.
Reduce stress on the piercing. Perhaps the biggest factor in the cause of hypertrophic scarring on piercings seems to be irritation or ‘mechanical stress’. It is thought that constant stress on a piercing (which heals slowly) causes the body to request more tissue than it needs because it’s being constantly stimulated by something interrupting or damaging the wound’s natural healing process. Common stresses for body piercing include:
- Wearing jewellery made from inadequate materials during healing – especially if you are allergic to store brought jewellery or ‘cheap metals.’ The only jewellery considered suitable for piercing is Titanium, PTFE plastic, glass (and, if you cannot get anything better, Bioflex or Bioplast plastics).
- Having jewellery that is an unsuitable length, width or shape. Jewellery that is too long, doesn’t sit right in your natural anatomy or is too thin (cuts into the skin a bit like cheesewire) can be very irritating.
- Wearing a ring in the piercing – rings move a lot more than bars causing friction and dragging in crusties as well as dirt and oils from the surface of your skin.
- Cleaning using harsh chemicals or antibacterial agents which remove the ‘natural’ levels of bacteria in a piercing and can cause damage to the delicate new tissue (see here for more information).
- Sleeping on the piercing – Your head is the heaviest part of your body so will put a lot of pressure on the piercing if you sleep on it at night, especially if you move about a lot too.
- Wearing clothing, hats or large earphones that rest or rub on the piercing.
- Wearing long hair down as it can get caught or wrapped around the piercing and often contains oil and dirt which could irritate the piercing itself.
- Playing with or moving the piercing frequently. Including taking it out to clean – a piercing should never be taken out until it is fully healed as it damages the tissue so badly!
- Knocking and catching the piercing. The sudden trauma caused by this is likely to cause the piercing to send out a call for more healing cells increasing the risk that too many may be called forth!
The most important step in treating hypertrophic scars on piercings is to remove stress, which stimulates an overproduction of tissue. Without this the bump is unlikely to disappear and could even increase in size for up to 6 months because the cause of the bump will still be there. Here are our recommended ways of reducing piercing stress:
1. Change your jewellery. Changing inadequate jewellery should help the bump as it will remove pressure and irritation. Although changing the jewellery too early can cause problems by damaging the delicate tissue, it is unlikely you will heal well at all with poor jewellery. It is best to have a piercer change the jewellery to a sterile bar where possible.
2. In some cases, especially with very stubborn hypertrophic scars, changing to PTFE or Bioplast plastic jewellery (PTFE is better if you can get it) can really help. This is because plastic is much lighter and more flexible than metal meaning it will put less pressure on the wound and will bend to move with your body, causing less irritation from general movement. PTFE and Bioplast also have smaller pores, meaning gunk sticks to them less easily and is more easily cleaned away, reducing irritation.
3. Clean your piercing using salt water soaks and avoid chemicals or antibacterial agents. The soaks are natural and are similar to the fluid (saline) already carried by your body so it won’t seem threatening, stress the healing process or cause damage. See here for more information.
4. Learn to sleep with your bent arm, cupped hand or special pillow cradling the piercing if you have an ear piercing. Laying with your piercing inside a ‘hole’ means that the weight from your head doesn’t rest on the piercing. Pillow shapes like Ring or ‘U’ shaped pillows (or even a towel rolled up inside a pillow case) are great for this.
5. Do not fiddle, twist or remove the jewellery. When you clean with the salt water soaks the water gets in under the jewellery for you so there is no need to move the jewellery around a lot when you clean. It used to be thought that jewellery would get stuck if it wasn’t twisted but we now know that this is not the case as the body builds a tunnel around the jewellery rather than healing over it.
6. Be careful to keep hair, clothing and accessories away from the piercing as much as possible. Things like tight t-shirts, lace bras and high rise jeans can rub on piercings in that area and hair can often get wrapped around ear piercings accidentally. Glasses can also knock or rub on nose and ear piercings!
7. Do not use moisturiser, foundation, face powder, talc or other cosmetics too near the piercing. These can clog up pores as well as irritating the piercing itself.
8. Do not try to treat the bump with chemicals or ‘harsh’ products. Things like hydrogen peroxide, alcohol, aspirin, neosporin, savlon, lemon or tea tree oil are likely to irritate a piercing that is still healing – bringing the bump back even as you are trying to remove it!
9. Do not try to squeeze or pop the bump. Even thought it may bleed from time to time the bump doesn’t actually have anything in it. It is made from solid tissue and you are likely to just upset it.
10. Take care of yourself. As we have mentioned nutrients can affect wound healing, so eating well and taking the supplements recommended above may help. Stress, alcohol and smoking all place strains on the immune system too so cut back where you can and make time for yourself to relax!
While it sounds strange to recommend using herbal treatments, piercings are quite delicate wounds and seem to respond better to gentler, natural treatments rather than chemicals while they are healing. Each of our recommendations have a scientific basis but shouldn’t be considered a substitute for professional medical advice.
Chamomile (Herb). The best thing to try first is chamomile tea. Chamomile is a natural anti-inflammatory, analgesic (pain killer) and is generally very soothing so it should help to calm the area, soothe away stress and reduce the stimulation and signals requesting more healing tissue than is needed. Pure Chamomile tea can be found in fruit tea section of most supermarkets and tends to be quite cheap.
To use simply add boiling water to the tea bag as normal and leave it to cool until it’s still hot but bearable to the touch. Add in 1/4 teaspoon of sea salt and soak your piercing under the water. Do this twice a day.
Otherwise simply use the chamomile teabag itself as compress over the bump for several minutes, twice a day; dipping it back into the tea when it gets cold.
If you have a ragweed or celery allergy do a skin test before using chamomile. You may also want to do a skin test if you have very bad hayfever or nut allergy.
Quercetin Powder. Quercetin is a natural supplement that can be found from most health food stores or online. Quercetin works by both inhibiting the overproduction of the signalling cells (which cause too much tissue) and by actually reducing the tissue itself. They also reduce histamine or ‘allergic’ response which encourages swelling. Swelling signals for healing cells so by inhibiting it less cells should come to the area and overproduce.
Break a single tablet down into powder and add it into a saline soak or some oil for a paste. Use twice a day.
Use the Quercetin twice a day. Do not use Quercetin if you are taking anti-biotics or certain medications (see here.)
Allium Cepa Powder or Merderma Gel. Allium Cepa are ‘red onion tablets’ most commonly found in the homeopathic section of health food shops. Mederma is a purpose made scar gel containing mostly onion extract but is much more expensive. Onion extract is particularly good at reducing hypetrophic scar colour but it also contains a high amount of Quercetin so it helpful at shrinking the bump itself too.
A single Allium Cepa tablet will need to be crushed and dissolved into warm water for a soak, or oil for a paste.The merdema gel can simply be applied after drying from a soak. Use twice a day.
Allium Cepa does not seem to interact with drugs in the same way as Quercetin does but as it still contains some Quercetin so caution is advised. If you are unsure, please ask the advice of a doctor or pharmacist.
Garlic Powder. Another supplement that has seen some success is the use of garlic which helps to heal wounds by increasing the production of new blood vessles and ‘normal’ skin tissue. It also helps to inhibit certain proteins and enzymes which can cause hypertrophic scarring.
We recommend using odourless garlic capsules or powder to avoid the strong smell this herb has! Open up capsules to get at the powder and either add it to your soaks or mix with oil to form a paste. Use twice a day.
You may need to be careful with this herb if you use certain medications (see list here). It can also interact with certain pain killers like Aspirin, Ibuprofen and other anti-inflammatories. Garlic may also irritate the skin in some people so do a skin test before use if you have sensitive skin.
Rosehip Oil. Rosehip oil is very gentle and has great anti-inflammatory properties. It is high in vitamin A which contains retinoic acid and is effective at ‘resurfacing’ scars, making them appear less irritated, smaller, and softer. Rosehip oil is also very soothing, reducing stress on the piercing itself. Finally, rosehip oil contains linoleic acid which helps to stop the cells signalling for too much tissue.
Simply apply a little to the bump twice a day after soaking. It is recommended that you massage it into the skin in a circular motion. This helps to break down the scar tissue.
Be careful using this oil if you take Warafin or Aspirin, Fluphenazine or Lithium. People with diabetes, G6PD or Iron deficiencies may also need medical advice before using Rosehip oil.
Fish Oil. It is thought that hypertrophic scars may lack certain levels of essential fats and that by adding them back in we can help the skin to heal. Fish oil is high in omega 3. A type of omega 3 fatty acid known as Eicosapentaenoic acid significantly inhibits the overproduction of tissue and interrupts the cell signaling process allowing the scar to reduce in size. Omega 3 also contains Linoleic acid (as above).
Simply apply a little to the bump twice a day after soaking. It is recommended that you massage it into the skin in a circular motion. This helps to break down the scar tissue.
Unfortunately there isn’t a decent vegetarian alternative to this oil. Brown and Red Seaweed also contain Eicosapentaenoic acid but in no where near the same concentrations as fish oils do, so it is unclear how effective they would be.
This oil may interact with people who take medications to lower blood pressure or slow blood clotting. This includes ibuprofen, aspirin, naproxen and other anti-inflammatory painkillers – which may cause more bruising and bleeding.
You can combine all or some of these treatments together. Just use equal amounts (50/50 etc) when combining the powders or oils together. We particularly recommend a chamomile salt soak with added quercetin and an application of cod liver oil to the bump after drying.
You should see some improvement after two weeks when using any these methods. It can take several weeks or even months for the bumps to disappear entirely, however. If you do not see any improvement after two weeks of twice daily treatments then try another method where possible. Medical advice should be sought if you are worried or concerned in any way.
If you have tried gentle treatments for several weeks and nothing appears to have changed then you should consider seeing a trained medical professional, who can give you much better advice.
Usually doctors suggest treating the bump as a possible infection first and may suggest an antibiotic cream like Fucidin cream. This is because hypertrophic scarring and the abscesses caused by minor skin infections can look very similar and are easily misdiagnosed.
Silicone. The best ‘self’ medical treatment for more stubborn bumps are products like hydro gel, silicone scar sheeting and silicone scar gels. However, piercings typically do not like to be covered so it would be best to use gels instead of sheeting until the piercing is healed. These products are highly recommended in the medical industry for treating hypertrophic scars and seem to have a reasonable success rate.
It is thought they work by inhibiting the wound signals so that less tissue is called over, working as a second skin so the scar remains well hydrated and protected and altering the chemical structure of the scar itself.
These products may even prevent hypertrophic scarring but would have to be used for around 2 months before piercing to have an effect.
Always read the leaflet before use or ask a pharmacist for advice.
Steroid Creams. You can also try to self medicate with a low dose steroid cream like hydrocortisone, which is used to treat conditions like eczema and is available over the counter at the pharmacist. Alternatively your doctor can prescribe you a triamcinolone cream like the brand Tri-derm which is generally more effective.
Steroids are often used by doctors to treat hypertrophic scarring as they thin the tissue and help to flatten out the scar itself so a low dose cream should be beneficial. Steroids also decrease the stability of the scar and its tissues, reduce inflammation and encourage re-absorption of the excess tissue.
Always read the leaflet before use or ask a pharmacist for advice.
Medical Intervention. Very stubborn or very large hypertrophic scars can be treated by doctors in the same way as keloids (steroid injections, laser treatments or freezing) but they can also be surgically removed because, unlike keloids, they do not have a high chance of reappearing afterwards. Some bumps have also responded well to interferon injections which activate parts of the immune system and are more often used in the treatment of certain cancers.
It is important not to treat hypertrophic scars on still-healing piercings with anything too strong. These treatments do see some success with people – especially on scars not on piercings. However, they can cause a lot of damage (and thus stress) to a piercing. If the piercing is still healing this can just stimulate the wound to request more healing cells – often increasing or bringing back the bump you are trying to remove.
Aspirin Paste. All aspirin paste does is just chemically burns away the top layer of skin from the hypertrophic scar and dries out the bump which makes it appear smaller.
It doesn’t really treat the root cause of the bump and can give you nasty chemical burns if you are not careful.
Some people find it works on scarring and lumps in mouth tissue because it destroys tissue much faster inside the mouth. However it can damage the gums and is only likely to work when the piercing has been removed or healed.
Hydrogen Peroxide (H202). Hydrogen peroxide works in a similar way by burning away a top layer of skin from the bump and, although some people recommend it, it can cause serious damage to a still healing piercing. It even says clearly on the bottle not to use it on puncture wounds which is exactly what a piercing is (even if its not being used directly into the piercing it may still interact or get inside).
Again, while hydrogen peroxide may make the bump smaller it doesn’t treat the cause and is so strong is likely just to irritate the piercing – or the surrounding tissues. Doctors do not recommend it for any form of wound care any more.
There is also a risk of damage to your hearing if the peroxide gets into your ear canal. We recommend avoiding it!
Compression Therapy. Compression is often used in the medical world to reduce hypertrophic burns scars and is considered to be quite effective. It is believed to work by reducing blood flow which decreases the amount of new tissue cells getting to the scar and increases the breakdown of collagen (tissue). It also reduces levels of oxygen and water to the wound which the cells need in order to produce the tissue and the tissue needs in order to stay alive, literally ‘killing off’ the bump. Certain enzymes and proteins needed by the overproducing cells are also thought to be restricted using this therapy.
However the therapy requires that constant even compression be present on the bump for around 23 hours a day for 6-12 months. This is usually achieved using custom-made clothes, splints and sleeves or little compression devices that clamp on to smaller body parts like the ear.
It is highly unlikely that you would be able to achieve the level of compression needed on a hypertrophic scar just by using tape, as some people suggest, because it is unlikely to be tight enough and evenly distributed enough to make a difference.
Piercings also do not respond well to being covered when they are still healing, bacteria can build up under the tape, the tape itself can be irritating and the force of the pressure on the jewellery is likely to be uneven and stressful. All of which could prompt the bump into growing.
Removing the jewellery is likely to be essential in getting this method to work which is why we don’t recommend it if you are wanting to keep your piercing.
Tea Tree Oil. Tea tree oil is stronger than people think and can damage a still healing piercing. Many people find they have reactions to it when used neat on normal, unbroken skin, let alone an open or upset wound.
It also has very effective antibacterial properties which can interfere with the healing process.
Tea tree oil has some restorative properties and can help wounds to close up properly so is often great with hypertrophic scarring on piercings that have been fully healed. Just make sure to do a skin test first before using the oil.
Scar Oils. Oils like Bio oil, Lavender oil, Emu oil &Vitamin E oil are reportedly great at treating scars as they soften the skin, encourage elasticity and the massaging motion helps to break down scar tissue and bring blood to the area (Along with healing cells).
Because hypertrophic scars are different from normal scars, however, it is unlikely that these oils will do as much as the oils we have recommended as they don’t treat the root causes of the bump.
Nut based oils like Almond and Walnut can be quite helpful as they contain linoleic acid like the rosehip we recommend does. In our view, however, rosehip oil has other beneficial properties that make it superior so it would be best not to substitute it where possible.
Vinegar. White vinegar and apple cider vinegar in particular have had medical uses attributed to them for thousands of years and are often used in home and folk remedies for wound healing.
It has been shown to have anti-microbial properties but actually damages healing cells in wounds unless very diluted (it is then not considered effective).It also causes burns or allergic reactions in some people.
It does increase blood flow to the area and may be helpful in stopping certain cells (seen in cancer trials) from multiplying, however, so there could be some merit in its use for hypertrophic scars.
Apple cider vinegar in particular seems to have been useful for some people treating hypertrophic scarring but we would not recommend it for still healing piercings due to it’s damaging, antibacterial and generally irritating nature.
Exfoliation. Often bicarbonate of soda, scar ‘peels,’ facial scrubs and ground almonds are often recommended for treating hypertrophic scars.
Exfoliation removes the top layer of skin and allows pigment-free tissue to reach the surface more quickly. This lessens the discolouration associated with scarring and reduces the appearance of the scar.
It is likely exfoliation will have little effect on hypertrophic scars themselves as they are a different type of scar and behave differently. It it likely that it will have no effect on inhibiting or reabsorbing the scar tissue itself.
This guide was written with the help of several independent sources, mainly medical journals. If you would like to learn more about hypertrophic scarring these are a great place to start.
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