As we’ve discussed on my blog previously, there are a number of medical conditions that can affect how you handle getting and healing piercings. We’ve looked at psoriasis, an autoimmune-based skin condition, and we’ve looked at Ehlers-Danlos Syndrome, a group of conditions that affect connective tissue in the body. Today, I want to talk about one of the most common skin conditions affecting over 30% of the population in America- Eczema! Most of us either have eczema ourselves, had it as children, and grew out of it, or know someone with it. And while many people do grow out of it or only deal with minor forms of eczema, this skin condition can absolutely still affect our experience of getting and healing piercings. So let’s look a little closer at how we can work with eczema to have happy, healthy piercings.
What is Eczema?
Eczema is an inflammatory skin condition that can cause itchiness, dry skin, flaky skin, blisters, and skin infections. Itchy and dry skin tend to be the most common ways eczema presents. There are multiple different types of eczema, with atopic dermatitis being the most common presentation. Many infants experience eczema shortly after birth but grow out of it as they age, although many folks will experience eczema on and off their entire life.
The exact cause of eczema is unknown, but it appears to be from an overactive immune system causing the skin’s barrier to become dry and itchy. There is a possible genetic component as well, from the protein filaggrin which helps regulate moisture in the skin. Some folks may be genetically predisposed to have less of this protein, causing eczema.
Eczema tends to present in flare-ups, where a certain part of the body experiences patches of itchy dry skin. These flareups are often triggered by irritants, including soaps, lotions, chemicals, fabrics, hot or cold temperatures, stress, and most notably, nickel is considered a very common irritant for eczema. While many folks have flareups that heal over time and the skin returns to normal, some folks may experience areas of their body, particularly around joints, that always stay slightly dry and itchy. Eczema can also cause areas of the skin to permanently thicken- this skin is sometimes a different color or texture than the surrounding tissue and more prone to experiencing flare-ups.
While there is no current cure for eczema, there are many treatments. Knowing and managing your triggers is a major factor, as is incorporating a regular bathing and moisturizing routine. There are many OTC and prescription creams that can be used to treat eczema, although there is some argument over the use of topical steroid cream as this can lead to topical steroid withdrawal which can cause severe skin irritation and issues for months.
Piercing Clients with Eczema
This next section is for the piercers ( but it’s honestly also for the clients). When it comes to clients who have eczema they can absolutely still get piercings! But how we approach piercing them is very different than how we may approach other clients of ours. To start, it’s important to remember no client is required to provide you with intimate medical details. While it does help us do our job better to know these things, legally we can’t force clients to disclose this.
In an ideal situation, your client will be forthcoming about having eczema, and you can go from there to figure out the best way to work with them. It’s often fairly easy to discern active or more advanced eczema during the cleaning and prep time with the client. Some clients have easily visible eczema patches on their ears or body. One big place I often notice this is behind the ear just under the hairline back there. That seems to be one of the most common locations for flare-ups. If I see signs of this I will usually ask a client gently “I notice some dry skin around/on your ear. Are you prone to dry skin or do you have any conditions like eczema or psoriasis?” And then we can discuss their unique situation. Some clients may have had eczema as a child but it’s since cleared up. Some may still have active eczema but it’s largely managed by medications. Some clients may have a permanent low level of eczema on certain body parts. What may look like a flare-up to us and may give us as piercers pause could be that client’s normal daily skin.
I like to discuss with my clients and see what their case is and what they are comfortable with. In the above example, this is normal for that client's ear and how it looks most of the time! They had quite a few other well-healed piercings so I felt comfortable adding more for them the same day. Other clients I may ask to reschedule for the actual piercing and come up with a plan for their piercings, aftercare, and how we approach piercing them. Much like piercing isn’t one size fits all, neither are our clients. We can tailor how we work for individual clients’ needs.
If a client has more severe eczema, if we know that wounds can trigger a flare-up for them, if they don’t have any other piercings, or if I’ve never worked on them before and don’t know how their body may respond, I like to take a more cautious approach. I will start with only one or two piercings that are easier to heal, and I will start with simple basic jewelry. My go-to is a simple plain titanium ball. This is for a few reasons. Because of the issues eczema can sometimes cause with healing starting simple is usually the best- plain implant-grade titanium beads and discs are your best friend. Once things heal we can worry about decorative pieces. I prefer beads over discs as excess dry skin can build up under the disc and be a bit trickier to heal, whereas beads are often easier to clean off and collect less debris and crust. I also find that folks with eczema usually fair better with larger initial jewelry for stability. For example, a 14g for cartilage including nostrils and septums, and a 16g for lobes. We can always downsize once healed, but often the more fragile tissue it more prone to cheesewire effects from thinner jewelry. Eczema can also sometimes cause thickening of the skin in areas like ears and nostrils- I see this often in clients with moderate to severe eczema. This is part of why I find slightly thicker jewelry often more stable, but it also means you may need a longer length than usual because of the thicker tissue. I have used up to 1/2 inch or 12.5mm for the initial length on a helix or conch on a client with very thick ears due to eczema. Again- there’s no one size fits all. Adjust your technique to your client's needs!
This also means we may be adjusting aftercare to our client's needs as well. For clients with eczema, I often suggest cleaning with just clean filtered water. I usually stay away from saline as it can be excessively drying for someone with eczema and cause flare-ups. If saline is going to be used it should be rinsed off well after. One of the biggest things I do when working with clients with any skin conditions is regular check-ins. Every 2-4 weeks I like to have clients send me updated photos of how things are healing, and let me know how the piercings feel. This is very helpful for understanding how different clients with eczema respond to piercing. Some clients are going to have very uneventful and easy heals. Others may struggle with prolonged healing, excessive secretion buildup, moisture irritations, cracking dry skin, bruising, or migration. Documenting the healing process and staying in touch allows us not only to learn how their individual body heals but make changes to aftercare and jewelry as needed to work through the healing process. This information then lets you know how to further with with that client- if they are healing well and easily I may do 2 piercings next time, or be willing to do a more difficult piercing. If they are struggling and having issues we may need to reassess piercing plans or aftercare to determine what we can safely do.
The biggest takeaway is to approach each client individually and with care. Everyone's eczema may look different, and there is no reason to rush into piercing and doing a lot. A slower, cautious approach to start will allow both you and your client to understand how they heal without overwhelming their body or potentially causing severe scarring or damage to already fragile tissue.
Getting Pierced with Eczema
The previous section discussed things from a piercer's perspective, but I also think it helps inform clients about what getting successful piercings with eczema can look like. What I hear more often than not is folks being told “You can’t have piercings with eczema” or piercers just turning them away and being unwilling to work with them. Your piercer should be asking you good questions about your eczema and your body, and listening to you. They should take time to thoroughly assess your skin and discuss a plan to approach piercing you with care and compassion. It’s a red flag if a piercer just turns you away simply for having eczema but it is also a red flag if a piercer says yes but doesn’t seem to really care, and is just going to take your money and pierce you willy nilly.
However, from you as the client I ask for patience. Working with any skin conditions well and ensuring your piercings heal well and without issues does require more work, and often a slower approach. I know you may be excited about all the piercings and all the pretty jewelry you want, but it’s very important to have patience. Plan to start off slowly and understand how your body heals before jumping into doing a lot of work. Be willing to compromise with your piercer on a plan that may mean waiting longer before your goal jewelry or goal piercings. Understand that your body may heal more slowly and your piercer may advise you to wait longer than originally planned to do more. You may also have more work to do with aftercare in order to get your body to heal, and it’s important to be committed to that extra work. From more cleaning to more checkups to more downsizes, be ready to do what you need to to get these piercings to heal. And remember that getting pierced can cause flare-ups, so make sure you are prepared for that before getting a piercing.
A Note on Topical Steroids
If we are going to discuss eczema, we have to mention topical steroids. This is one of the most commonly prescribed treatments for eczema and it has pretty good results. However, these medications do have side effects we have to consider as piercers. Thinning of the skin and tissue fragility at the site is not uncommon, especially when these medications are applied under a bandage or wrap. This can leave skin more fragile and even if it’s been a while since a client has used this medication, if they have used it on the area we are piercing in the past the tissue may not respond how we expect. Some other side effects can include growing excess hair in the area, changes in skin pigment, stretch marks, and tropical steroid withdrawal. If you use these medications you should refrain from doing so for the entire healing period of your piercing unless otherwise advised by a doctor or medical professional. Extra care and monitoring should be given to the piercings done through areas with recent topical steroid use.
Eczema is an incredibly common skin condition that thousands of people deal with daily. Despite this, it doesn’t have to be a barrier to getting the piercings and modifications you desire. With an informed piercer, a cautious and gentle approach, and some patience, we can absolutely make beautiful piercings happen for people with all levels of eczema. Happy healing!