Earlobe Keloids Research Articles

Efficacy of Immediate Postoperative Single Fractional 10Gy Radiotherapy for Earlobe Keloids.

The ear is a common site for keloid formation, typically due to ear piercing or trauma. Auricular keloids are always difficult to treat and pose a challenging situation. The purpose of this study is to present our experience treating earlobe keloids through complete surgical excision followed by immediate postoperative single fraction 10Gy radiation therapy either on the same day or the next day. The authors retrospectively evaluated 48 patients with 71 earlobe keloids treated with complete surgical excision followed by single-fractional 10Gy radiotherapy within 24 hours from May 2021 to December 2022. The outcome was reported with a recurrence-free rate and side effects. The mean follow-up period was 20.8 months. All patients tolerated the treatments well. The overall recurrence-free rate was 100%. There were only 2 grade III radiation dermatitis. There were no reports of second malignancies or severe complications. The authors have obtained excellent outcomes from treating earlobe keloids through complete excision followed by postoperative radiotherapy with a single fractional dose of 10Gy on the same day or the next day.

Surgical management of ear lobe keloid: A case report

A keloid can be described as an excessive development of dense and fibrous tissue that occurs during the healing process of a skin injury. Most often occur on the chest, shoulders, upper back, back of the neck, and earlobes. Despite decades of research, the pathophysiology of keloids remains incompletely understood.

Custom-made dental prosthetic clip for postoperative management of earlobe keloids

Abstract Earlobe keloids are a common condition with varied and cross-specialty presentation. The condition is often recalcitrant and difficult to treat on account of its location. Frequent recurrences following excision is often frustrating for the patient and the surgeon. Application of pressure along with intra-operative and postoperative intralesional steroids is a popular choice and is in vogue by surgeons and dermatologists. However, considering the uniqueness of the structure for every individual, it is often difficult to ensure one size fits all when using pressure therapy as an adjunct. We designed a simple PMMA dental prosthesis to ensure comfortable yet effective constant pressure over the lesion to ensure complete aesthetic outcome without recurrence in an operated earlobe keloid.

Efficacy of a multimodal approach of laser therapy for earlobe keloids management in dark population.

Patients with keloids are often younger than 30 years old and have darker skin. To evaluate the efficacy and safety of CO2 laser therapy in the management of earlobe and helix keloids in dark subjects. A total of 21 dark patients (five men and 16 women) presented with the earlobe and ear helix keloids, with a mean age of 30.5 (±6.7) years and with phototype between III-VI, were enrolled. In order to improve their earlobe and helix keloids, all patients underwent a single session of CO2 laser therapy immediately followed by a pulsed Dye laser procedure. A single well-experienced doctor performed all treatment sessions and the response to treatment. Patients were followed-up for 6 months after termination of therapy. Clinical images were examined and collected: all patients were examined clinically and with Dermoscopy. The majority of the patients treated show complete remission of keloid lesions. Clinical photographs show a visible aesthetic improvement of several types of keloids in dark subjects. Our data demonstrate that this combined laser therapeutic protocol appears to be effective and well tolerated for the management of earlobe and helix keloids in dark subjects, with no high recurrence rate and avoiding the adverse effects and lengthy recovery time.

Early outcome of surgery, triamcinolone and silicone gel combination therapy for earlobe keloid: our local experience

Background: Earlobe keloids cause facial disfigurement, physical, emotional and psychological burden to patients, while posing an intriguing treatment challenge to the plastic surgeon. Different options of combination therapy have been used in the treatment of earlobe keloids with varied success rates. Methods: This interventional prospective hospital-based study was carried out in Irrua Specialist Teaching Hospital, Irrua, Edo State, over a 15-month period (October 2017 to December 2018). Forty-two patients with earlobe keloids who met the inclusion criteria were serially recruited into the study. Forty-eight earlobe keloids in 41 patients had the intralesional excision biopsy, intralesional triamcinolone injection and silicone gel combination therapy. A modified Sharquie et al’s scar grading system was applied pre-intervention to record the baseline scores and post-intervention to evaluate the patients’ rate of response. Post treatment complications were identified, and the patients were followed up for six months. Results: Most of the patients with earlobe keloids fell in the age group 21-30 years and the male-female ratio was 1:19.5. Multiple earlobe piercing had significant association with the development of earlobe keloids. 95.8% of treated lesions had complete response to therapy. Two (4.2%) patients had dyschromia following treatment. Conclusions: The triple therapy combination of intralesional excision biopsy, postoperative intralesional triamcinolone injection and topical silicone gel application is a readily available, safe and efficacious treatment modality for earlobe keloids. Thus, it can be used as a first-line treatment modality.

Limberg’s flap technique: a defect repair method for ear lobe reconstruction in recurrent earlobe keloids: a case report

The article acts to focus and aid in the localization of sound. Its shape is aesthetically important as it shows considerable inter-individual variability which reflects its multicomponent and is quite challenging for the surgeons during the planning of reconstruction as it is complex and equally important. It’s complex undulating structure and topography includes fibro elastic cartilage, perichondrium and the skin. The ear lobule is an important reference point for symmetry of the face and its loss causes an obvious aesthetic abnormality. Excessive healing can be as significant as delayed or non-healing. Recurrent earlobe keloids are among the most challenging conditions and may have significant psycho-social impact for the patient. Their aesthetic considerations are serious and despite a variety of treatment options, they often proved to be recurrent. It is likely that more operative interventions are required for excessive healing. Type II A defects are characterized by loss of the ear lobule without presence of a nubbin of tissue attached to the cheek. The goal of surgery should be an aesthetically pleasing reconstruction that maintains symmetry with the opposite ear lobule. The Limberg‑flap technique using a doubled‑over skin flap allows a one stage reconstruction of the ear lobule. The aesthetic results are generally well acceptable and hence here we present a case where we combine this technique with the excision for better results of long-term refractory cases.

Management of Earlobe Keloid by Triple Combination Therapy (Core Excision, Fillet Flap, and Intralesional Corticosteroids): A Case Report

Background: Keloid is a growing neoplasm characterized by the proliferation of benign fibroblasts. The chest, shoulders, head, especially the ear lobes, neck, arms, and upper back are the areas most commonly affected by keloids. The use of a fillet flap allows dissection of the keloid core and leaves loose skin for wound closure. This study aims to describe the surgical management of keloids in the auricular region using the core excision technique with a keloid fillet flap with a combination of corticosteroid injections.
 Case presentation: A 54-year-old man came with the main complaint of a red lump with hard consistency and itching on the right ear. The management of this patient was surgery using the core excision technique with a keloid fillet flap followed by intra-operative intralesional and immediate post-operative corticosteroid injection and then programmed for corticosteroid injection at the next follow-up. Post-operative therapy was given cefixime 2x100mg and oral analgesic mefenamic acid 3x500mg for 5 days.
 Conclusion: Keloid surgery is the treatment of choice because it produces good cosmetic results quickly. Routine follow-up and additional therapy are required to prevent a future post-operative recurrence.

Single-cell RNA-seq reveals the communications between extracellular matrix-related components and Schwann cells contributing to the earlobe keloid formation.

Keloid is a major type of skin fibrotic disease, with one prominent feature of extensive accumulation of extracellular matrix (ECM) components, and another feature of pain/itching, which is closely related to the peripheral nervous system (PNS). However, the molecular pathogenesis of these two prominent features still needs to be further explored. In the present study, we performed single-cell RNA sequencing (scRNA-seq) on clinical earlobe keloid samples and adjacent normal skin samples and constructed a keloid atlas of 31,379 cells. All cells were clustered into 13 major cell types using cell-type-specific markers. Among them, fibroblast, vascular endothelial cells, and smooth muscle cells were defined as the ECM-related populations according to their ECM-associated functions. Also, we found that Schwann cells (SCs) were the main neuron cells of PNS in the skin. Interestingly, the cell proportions of ECM-related populations, as well as SC were increased significantly in the earlobe keloid compared to the adjacent normal tissues, suggesting an important role of these cell types in the development of the earlobe keloid. Comprehensive cell-cell interaction analysis at the single-cell level revealed a strong interaction between SC and ECM-related subgroups which might be mediated by SEMA3C signaling pathways and MK/PTN gene family, which are found to be mainly involved in promoting cell proliferation and migration. Moreover, further exploration of the interactions of ECM-related populations and SC in different keloids, including earlobe keloid, back keloid, and chest keloid revealed an increasing amount of TGFβ-TGFβ receptor interactions in chest/back keloids as compared to earlobe keloid, which suggested the anatomic site-specific pathogenesis in different keloids. Altogether, these findings suggested the interactions between ECM-related populations and SC contributing to the earlobe keloid formation and helped us to better understand the pathogenesis of keloids.

Giant Keloid of the Ear Lobule: Case Report and Brief Review of Literature

Keloids are benign lesions arising from fibrocollagenous growths that rise above the surface of the skin and extend beyond the edges of the original wound. They usually arise after a cutaneous insult, but idiopathic spontaneous etiology has also been reported. They rarely regress spontaneously. And they are difficult to treat due to high recurrence. We report a case of giant earlobe keloid in a 35-year-old male patient with good response after surgical treatment and local radiotherapy. Giant keloids present a treatment challenge due to complex and poorly understood pathophysiology. Few are the successful reports in the approach. In this article, we review the available literature to discuss the pathophysiology and treatment modalities that can be used to prevent recurrence of keloids

Screw-loaded compression device for auricular keloid

Pressure therapy is widely used in the management of keloid mass and for preventing postexcision recurrence of earlobe keloid. Although various types of compression devices are available, the pressure applied by these devices is uncontrolled and associated with the risk of pressure necrosis. This article presents a novel design for a compression device with threaded connectors to control the amount and direction of the pressure applied on the keloid mass.

Outcomes of Surgical Excision and High-Dose-Rate Brachytherapy for Earlobe Keloids.

BACKGROUNDRadiotherapy as an adjuvant therapy to surgical resection has shown variable rates of recurrence treating earlobe keloids. The purpose of this study was to describe our experience with surgical excision followed by high-dose-rate brachytherapy and present our outcomes after 24 months of follow-up.METHODSRetrospective chart of 14 patients with 14 earlobe keloids treated with surgical excision followed by high-dose-rate brachytherapy, between January 2015 and May 2016 were enrolled. Database included demographics, Fitzpatrick skin type, laterality, lesion size, and follow-up visits information. Outcomes were assessed in terms of keloid recurrence rates, complications, and patient subjective aesthetical result satisfaction after 24 months of follow-up.RESULTSAll procedures were completed without complications. Three patients experienced keloid recurrence after 6 (14.28%) and 12 months (7.14%). Three patients experienced mild signs of self-limited post-radiation dermatitis. Self-assessment of aesthetical result was considered “very good” in 71.43% of patients. CONCLUSIONSurgical excision followed by high-dose-rate brachytherapy is secure and effective to treat earlobe keloids, and can be considered a first line combined treatment. Larger clinical trials comparing different irradiation protocols are still needed.

Biomechanical characterization of earlobe keloid by ring suction test

Keloid is a fibro-proliferative disease characterized by an overgrowth of scar tissue beyond wound margins. Keloids appear on some specific anatomical sites often believed to be permanently under m...

Optimizing Surgical Procedures of Auricular Keloids According to Their Anatomic Morphological Features.

Aesthetic surgical reconstruction of auricular keloids is still a conundrum. This study introduces our experiences in analyzing the anatomic morphological features of auricular keloids, and devising optimized surgical procedures accordingly. A total of 129 ears with auricular keloids were classified and operated. All patients were followed up for at least 12 months. According to their anatomic positions, auricular keloids were divided into 3 Groups (A, B, and C). The morphological features of keloids were further interpreted according to Chang-Park classification of earlobe keloids. The authors optimized surgical procedures according to the anatomic morphological features from a range of surgical techniques. The recurrence rate of Group C was statistically higher than Group A and B. There was no significant difference in recurrence rate between keloids treated with "primary suture" and "filleted flaps." According to the anatomic positions and morphological features of auricular keloids, we could conveniently devise optimized surgical strategies to obtain aesthetic reconstruction of auricular keloids.

Experience Treating Earlobe Keloids with Laser Diode 980nm Excision Followed by Triamcinolone Infiltration.

Lasers have a favorable synergistic effect when combined with other modalities of treatment against keloids. Different types of lasers have been used with triamcinolone infiltration, resulting in promising success rates. The purpose of this study is to describe our first experience treating earlobe keloids with 980 nm laser diode excision followed by triamcinolone infiltration and present our outcomes after 24 months of follow-up. A retrospective chart review of 11 patients with 14 earlobe keloids treated with excision using a 980 nm laser diode followed by triamcinolone acetonide infiltration, between January 2015 and May 2016. Database included demographics, Fitzpatrick skin type, laterality, lesion size, and postoperative visits information. Outcomes were assessed in terms of keloid recurrence rates, complications, and patient subjective aesthetical result satisfaction after 24 months of follow-up. All procedures were technically completed, and follow-up accomplished without attrition. One (7.14%) patient experienced keloid recurrence after the third month. Four (28.57%) patients experienced early wound dehiscence, successfully treated with debridement and re-suture. Self-assessment of aesthetical result was considered "very good" in 64.28% of patients. Surgical excision with 980 nm laser diode followed by triamcinolone infiltration is well-tolerated and shows favorable results treating earlobe keloids, and can be considered a first-line treatment. Comparison between different types of lasers and control groups in large clinical trials is warranted in order to obtain strong clinical evidence for clear indications and recommendations. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Imiquimod to prevent keloid recurrence postexcision: A systematic review and meta-analysis.

Imiquimod 5% cream, an immune response modifier capable of inducing IFN-α, TNF-α, and interleukins 1, 6, and 8. It was approved for use in the management of genital and perianal warts and soon embraced as a method to diminish the recurrence of keloids postexcision. A previous meta-analysis included four studies. This meta-analysis is part of a larger systematic review project on the effect of moisturizers on scars. It was conducted following an a priori protocol and the guidance of the Joanna Briggs Institute. Databases searched included PubMed, CINAHL, Embase, and Web of Science. After screening and critical appraisal, subgroup meta-analysis on excision method and location of the keloid was conducted using the Miller approach for proportional meta-analysis and a random effects model. Seven studies, including 77 participants and 82 keloids were included. Meta-analysis revealed a recurrence rate of 39% (95% CI = 8.474.4%; I2 = 87.5%) following application of Imiquimod postexcision. The use of primary excision or tangential excision did not alter the outcome. For analysis based on the location of the keloid scar, earlobe keloids had a recurrence rate of 5.4% (95% CI = 0-21.7%; I2 = 52.9%). For keloids excised from other areas (predominantly on the trunk) recurrence rate was higher, at 76.8% (95% CI = 36.1-100%). For keloids, Imiquimod application postexcision results in highly variable recurrence rates. There is very low certainty in the effect of Imiquimod and it therefore is not recommended as a treatment option.

Management of Ear Keloids Using Surgical Excision Combined with Postoperative Steroid Injections.

BACKGROUNDEar keloids are a challenging problem that affect people of different races with substantial aesthetic consequences. Various types of adjuvant therapies, including intralesional corticosteroid injection are advocated to lower recurrence following excision. We investigated the efficacy of a protocol combined of excision and postoperative intralesional triamcinolone acetonide (TA) injection for treating earlobe keloids in a group of Iranian female patients.METHODSA retrospective analysis of 21 patients representing 31 ear keloids treated by a single physician between 2013 and 2017 was conducted. All keloids occurred after ear piercing in female cases. Postoperative intralesional TA injection was administered once monthly and continued for several months based on the patients’ clinical progress. Results were assessed according to Kyoto scar scale.RESULTSThe patients’ mean age was 24.29 years and ranged from 16 to 40 years. After the surgery, the follow-up period ranged from 10 to 29 months (mean: 15.93 months) and patients were given TA intralesional injections 3 to 6 times (mean: 4.22 times) with no complication or adverse effect. Of the treated keloids, success was achieved in all of 31 keloids (100%) and final evaluation revealed that the mean Kyoto scar scale was significantly decreased. No recurrence occurred. CONCLUSIONSurgical excision followed by postoperative intralesional TA injection can be suggested as the primary protocol for the treatment of ear keloids considering its durable results and economic advantage.

Pediatric earlobe keloids: Outcomes and patterns of recurrence

PurposeKeloids occur as a result of abnormal wound healing and as many as 70% of keloids and hypertrophic scars affect the pediatric population. Earlobe keloids, similar to lesions elsewhere in the body, remain a challenging problem given the high rates of recurrence and lack of consensus regarding treatment strategy. This study aims to evaluate the outcomes and patterns of recurrences following treatment of earlobe keloids in a large cohort of pediatric patients to facilitate identification of the optimal treatment strategy. MethodsAll pediatric patients who underwent surgical therapy for earlobe keloids over a 10-year period (2004–2015) were identified and demographic, clinical and outcomes data were collected. A follow-up phone survey was administered to assess rates of long-term recurrence and overall satisfaction with the treatment strategy. Data analysis was performed using Student's t-test and Fisher's exact as appropriate. ResultsA total of 94 patients with 135 keloids were identified. Mean age was 14 years with slight preponderance of females (52%) and a majority (75%) of the patients were African American (AA). Mean keloid size was 2.4 cm (0.25–11 cm) with ear piercing being the most common inciting etiology. Excision with steroid injection (59%) was the most frequent treatment approach followed by excision alone (25%). During a median follow up of 2 years, keloid recurrence occurred in 27 (28.7%) patients, 19 (70.4%) underwent additional therapy with 10 (52.6%) re-recurrences noted. Median time to recurrence was 23 months, with a slightly higher recurrence rate in AA patients (32%; p = 0.26) and in those age < 10 years (50%; p = 0.11). ConclusionThis represents the largest series of earlobe keloids treatment in children. Our data suggest that recurrence rates are unaffected by the age at excision and race of the patient. Moreover, adjuncts to excisional therapy such as steroid injection, compression therapy and radiation also did not appear to influence recurrence. Given the pattern of recurrences studies with longer term follow-up are needed to assess the efficacy of treatment strategies. Type of studyCase series. Level of evidenceIV

Retrospective study of immediate postoperative electron radiotherapy for therapy-resistant earlobe keloids

Keloid resection followed by adjuvant radiotherapy is the most efficacious treatment for keloids. However, for earlobe keloids, an optimal protocol for the total dose and fractions of adjuvant radiation has not yet been established. We retrospectively analyzed the efficacy and safety of immediate three-fraction electron radiotherapy after operation for resistant earlobe keloids. From 2011 to 2017, three-fraction electron radiotherapy with single dose of 5 Gy was given postoperatively to 23 patients with 30 keloids in our hospital. The first fraction of adjuvant radiotherapy was administered within 2 h of surgery, and the other two sessions were completed within the next day or two. Five (16.7%) primary keloids and 25 (83.3%) recurrent keloids were examined in this study. The primary endpoint was the local control rate, which was 86.7% after a median follow-up of 26 months (14–93 months). Secondary endpoints were acute and late procedure-related complications, and no severe complications were observed after combination therapy. Our results suggest that three-fraction electron radiotherapy after excision within 2 days of surgery is a safe and effective protocol for the prevention of earlobe keloid recurrence that can also improve patient compliance and comfort.

Use of balneological methods in complex treatment of earlobe keloids

Use of balneological methods in complex treatment of earlobe keloids

Prevention of Earlobe Keloid Recurrence After Excision: Assessment of the Value of Presurgical Injection of Triamcinolone

The ear is commonly involved in keloid formation, being often pierced. This study estimates the value of pre-excision triamcinolone injection of earlobe keloid, by comparing recurrence rates in patients who only received postexcision triamcinolone injection to those who had it administered before and after excision.The prospective intervention study involved 18 keloid lesions in as many consenting patients who presented with pedunculated earlobe keloid from January 2005 to January 2007.Triamcinolone doses were administered 10 mg/cm of lesion or sutured excision site. Each patient was followed-up for 10 years. Aggregate length of keloid lesions at presentation was 24.4 cm in Group A and 26.5 cm in Group B. Aggregate length of postexcision sutured wound in Group A was 16.1 cm, and 14.8 cm in Group B. Group A patients received a total of 1610 mg of triamcinolone, while a total of 4660 mg of same drug was administered to Group B patients, among whom 3180 mg was delivered presurgically. Total number of clinic visits during the course of treatment in Group A was 10, while that of Group B was 22. No patient with recurrent keloid was recorded in both groups.The authors concluded that there is no advantage to presurgical injection of triamcinolone when excision is considered as part of treatment protocol of a keloid lesion. This study helps to eliminate an ostensibly needless part of a commonly used treatment protocol.