Below is an exchange with a woman who wanted input on her HCH piercing.

After I saw the image I commented:

Yeah, that looks mighty angry. Are you confident that the jewelry is high quality? Was the piercer able to insert and close the ring without using any tools?

What product are you using to clean? Are you following the instructions as explained here? http://piercingbible.com/piercing-care

What is your recipe for the salt water, and are you rinsing it well when you're done?

If yes to all of the above, then I think you should consider a visit to the doctor.

H Elayne,

Yes, it feels mighty angry! 
I am following standard aftercare (as recommended by the APP) with saline compresses, made with 1/4 tsp. non-iodized sea salt to 8oz of bottled water (perhaps i'll try it with distilled water to see if it makes a difference).  Yes, I've been rinsing & drying with paper towel and making sure to wash my hands before handling the piercing (and not touching faucets, doorknobs, etc).  I've also kept clothing & bedding clean. The only other products I have used are Dr. Bronner's castile soap & chamomile infusion compresses (from organic chamomile tea).  I find the chamomile to be soothing.  I've gotten the piercing to drain a small amount of puss.  It was definitely puss.  :(

My piercer tells me the jewelry is implant grade steel.  I have not asked to see mill certs, but he opens & closes jewelry by hand.  I believe all his jewelry comes from anatometal. 
I went to him for advice today.  He offered to take the jewelry out & recommended I try Bactine.  I understand that jewelry must stay in an infected piercing to allow for drainage, and that Bactine is inappropriate for use on healing piercings.  He told me that abscesses form only in "one in a million" cases - a statement i took with a grain of salt.  Ugh.  So I opted to keep the jewelry in and have made an appointment with the doctor tomorrow.  I will mention bactroban to her, and make sure she prescribes a cream or gel if she prescribes topical treatment. 
 
I will continue to be diligent in my saline compresses, taking ibuprofin, and keeping the area clean for the time being.  I will also try and locate my old syringe the oral surgeon gave me for flushing empty tooth sockets, clean it thoroughly, and use it to gently irrigate under my hood, since I haven't had good access to the underside of the piercing.  Hopefully that'll flush yucky stuff out.  

Thank you for writing the Piercing Bible, it has been a wonderful reference!  I would actually like to become a piercer myself.  A good one, like you!  I've been considering it for a long time & have decided that i want to go for it.  I have been learning all I can from BME and the APP websites for the last couple years in order to gain some prior knowledge, but of course there is no substitute for an education from a qualified professional. I was originally thinking of trying to convince my piercer to let me apprentice for him, but it seems that his aftercare and troubleshooting recommendations are flawed (he also recommends diluting dial soap and swabbing the diluted soap onto the piercing, a direction i do not follow, especially in my nether region). So I will have to try and find another piercer in the greater Seattle area who meets all current APP standards and try to convince her/him of my sincere intentions.

That sounds really frustrating, especially since you're doing everything correctly and have been working hard to make sure everything is okay. Please keep me posted.

Did you dilute the Dr. Bronner's? I'm still trying to figure something to explain the problem you're having....

I'll be piercing in Seattle before the end of the year. Part of my plan for today is to get the dates established. I'll be piercing at Pierced Hearts: http://www.piercedheartstattooparlor.com/

Yeah, I was really frustrated.  I really like the piercing and was trying to be SO careful to keep my hands & everything clean, and care for the piercing correctly.  But I suppose whenever a person gets a piercing they accept the risks and infections can occasionally happen, in spite of our best efforts.

I went to the doctor and everything went well.  The nurse and the doctor both were compassionate, open minded & accepting.  They were curious, more than anything else.  Nobody even asked me to remove the jewelry!  I thought it was cool that the doctor asked me, broadly, why do people get body piercings.  She seemed genuinely curious.  So I explained how people do it for a variety of reasons, aesthetics, right of passage, sensation, commemoration, etc. The nurse seemed fascinated and asked me lots of questions about piercing; does it hurt, does the piercer use a gun, topical anesthetic, etc.  I even brought your book along and showed it to them.  :)

The doctor agreed it was infected & prescribed Bactroban cream (I made sure to request a cream or gel) & about a weeks worth of oral antibiotics.  Within the first 12 hours of treatment my condition drastically improved, and almost 48 hours later my piercing doesn't hurt anymore & looks almost back to normal!  So it must have been a bacterial infection.  I continued saline soaks (it's been draining a lot now) & twice a day cleaning (I'll return to once a day after it's all better).  I lather up the Dr. Bronner's in the shower with water so I guess it's somewhat diluted.  The bottle doesn't say it needs to be diluted for regular cleaning.  I use Dr. Bronner's lavender soap because it feels milder than the peppermint soap. I don't think the strength of the soap is bothering it, but I'll definitely keep an eye on it. 

My only concern now is jewelry size.  I'm uncertain whether I should seek a jewelry swap.  I developed a couple of very small abscess type legions adjacent to the piercing (they're almost gone now) and I remember reading that such an issue can be caused by too tight of jewelry.  Judging from the pictures, do you think the ring looks too small for initial jewelry?  Now that the swelling has gone down, the jewelry seems to rest flush with my body, but I'm still a little concerned. 

Thanks for the update. I'm thrilled that your healthcare practitioners were so compassionate. I know not all piercees find themselves in that same situation. I'm also glad to hear that the treatment was effective so quickly. Whew!

Even with the swelling you experienced, the jewelry didn't really look too small, so I think you should be okay with that.

Since you took such wonderful care of the piercing, it makes me wonder if the piercer did something wrong? After hearing his troubleshooting suggestions, I have to admit I have concerns about his qualifications.

Yes, I was so relieved the doctor was no nice.  I always get nervous for no reason in the doctor office (white coat syndrome, haha), and was especially nervous that time.  What a relief!

Alright, I'm glad I can leave the jewelry in.  My piercing started to randomly bleed freely for a bit last night after I was done soaking & cleaning, but didn't hurt.  Kinda strange, I figured it was just more drainage.  I suppose something could be up with my (former) piercer's hygiene & sterilization techniques, I'm not sure.  My brother & many of my friends have been pierced by the same guy without problems.  It took just under 2 weeks after piercing for the infection to develop.  I always knew his aftercare suggestions were a bit off (he prescribes APP approved saline soaks/compresses, in addition to the diluted Dial soap), but I had thought his piercing skills & sterilization methods were sound.  Oh well. 

Sure, go ahead, I have no problem if you use my photos & e-mails. Hopefully other people can learn from all this!

I'm curious, the Piercing Bible doesn't mention anything about D-ring CBR jewelry.  I have a couple of 2-year-old nipple piercings with 14g 5/8" CBRs & the rings seem to be causing some friction (hurts my nipples when I bend forward after soaking, jewelry doesn't rest flush).  My nipples are rather small for girl nipples, the rings look big on me, but clearly they're a poor fit. I was thinking of getting 1/2" or 5/8" D-rings put in to relieve pressure on the sensitive fistulas.  I had barbells initially, but the balls were pressing into my skin, also causing pressure & irritation. I guess I could go back to barbells, but with discs instead of balls, but I like the way rings look better.  I'm not sure if bigger rings would fit in my bras very well.  But I could be wrong. 

What do you think of D rings?  I was about to set out on a quest for an expert piercer in the Seattle/Tacoma area who stocks implant grade D-rings.  I imagine such rings would have to be pulled open & fairly straight to go in comfortably. 

Thanks Elayne!  I hope my HCH is healed sufficiently by the time you get to Seattle.  I'd like you to redo my VCH!  If not, I'm sure I can find another spot for you to poke a new hole.  :)

Another option for your nipples would be barbells with long enough posts!

I briefly mention D-rings (and other shapes) on page 69 of The Piercing Bible:

The CBR is a simple design that has several advantages: it is extremely versatile, secure when properly fastened, and easy to manufacture. One disadvantage is that it is possible for the ball to fall out and become lost. The ring can follow, and your piercing can shrink—or even close. This type of ring can also be awkward for the uninitiated to handle and may take strength and dexterity to operate, depending on the gauge, diameter, and quality. The CBR is made in other shapes and forms (such as square, teardrop, triangle, D-ring, and so on), but these are best for healed piercings.

Those could be a good option for you.

This company makes them, and they are actually based in Seattle! http://www.bodycircle.com/merchant.ihtml?pid=15&lastcatid=2&step=4 or check out Pierced Hearts (where I'll be piercing): http://www.piercedheartstattooparlor.com/