Earlobe Keloids Research Articles

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.

The effects of postoperative intralesional corticosteroids in the prevention of recurrent earlobe keloids: A multispecialty retrospective review

The effects of postoperative intralesional corticosteroids in the prevention of recurrent earlobe keloids: A multispecialty retrospective review

The Effects of Postoperative Intralesional Corticosteroids in the Prevention of Recurrent Earlobe Keloids: A Multispecialty Retrospective Review.

Effective treatment of keloids is challenging because the recurrence rate after surgical excision is high. Data on the best treatment practices are lacking. To investigate the recurrence rate after surgical excision of earlobe keloids based on a postoperative intralesional corticosteroid injection protocol. Retrospective chart review was performed from January 1, 2005, to March 31, 2016, of patients who had excision of ear keloids within the departments of dermatology, otorhinolaryngology, and plastic surgery. The number of postoperative injections was recorded, recurrence was reported by the patient, and the efficacy of an injection protocol was evaluated. There were 277 charts reviewed. Appropriate data were available for 184 patients. A statistically significant difference was found with recurrence associated with a lower number of injections (p < .001). Keloids were more likely to recur if they were not treated with a planned serial injection protocol (p < .001) or if they were treated outside the department of dermatology (p < .001). Intralesional corticosteroid injection after surgical excision of earlobe keloids statistically minimizes the risk of recurrence.

Pediatric dermatology procedures and pearls: Multimodal revision of earlobe keloids.

Keloid scars are benign proliferations of fibrous tissue and collagen that usually occur in response to cutaneous injury. Many treatment modalities have been described in the literature, with variable rates of recurrence and no clear consensus. Keloids remain a therapeutic challenge to patients and physicians alike. Herein we describe a novel technique for treating recurrent earlobe keloids in an outpatient setting with multimodal therapy including shave removal followed immediately by ablative fractional laser resurfacing (AFR) and laser-assisted delivery (LAD) of corticosteroids.

Histological analysis of hyalinised keloidal collagen formation in earlobe keloids over time: collagen hyalinisation starts in the perivascular area.

Keloids grow and do not regress. They are characterised histologically by hyalinised keloidal collagen (HKC). HKC amounts vary, and the mechanism by which they form is unclear. To clarify how HKCs form and whether their formation associates with specific clinical features, we studied the histological findings of earlobe keloids and compared them with respective clinical features. A total of 50 earlobe keloids from 43 patients were used for histological analysis of keloid size (mm2 ), HKC area (mm2 ) and HKC area ratio (%). As a result, keloid durations ranged from 3 months to >13 years. Early-stage keloids exhibited little HKC and a tendency for the HKCs to locate in perivascular regions. In later-stage keloids, the HKCs were extremely interconnected and formed a thick bitten donut-shaped region. HKC area ratios correlated positively with keloid duration (r2 = 0·58, P<0·05). HKC area ratios and keloid durations did not correlate with keloid sizes. These patterns of HKC formation and growth may explain why local therapies, which effectively remove fibroblasts and accumulated collagen but not HKCs, are ineffective in older keloids. Keloids should be promptly treated after diagnosis, and older keloids with extensive HKCs may require surgical excision followed by radiotherapy.

Massive ear keloids: Natural history, evaluation of risk factors and recommendation for preventive measures - A retrospective case series.

Keloid disorder (KD) is an inherited wound healing ailment, frequently seen among Africans /African Americans and Asians. Genetics of this disorder continues to be obscure and poorly understood. Clinical manifestation of KD is quite variable and very diverse, spanning from individuals with one or very few small keloidal lesions, to those with numerous and very large lesions covering large portion of their skin. Ears are common locations for development of keloids. Ear piercing is by far the leading triggering factor for ear keloid formation in genetically predisposed individuals. Although there are numerous publications about ear and earlobe keloids, there is a void in medical literature about massive ear keloids. This paper focuses on the natural history of massive ear keloids and risk factors that lead to formation of these life-changing and debilitating tumors and recommendations for prevention.

Fillet flap method of ear keloid repair and its cosmetic outcome: our experience

Background: Formation of keloid after cosmetic or traditional ear piercing is a very distressing condition for the patient. Ear lobe keloid has been treated with excision followed by primary suture, healing by secondary intention, skin graft or local flap. Fillet flap technique has come up with good cosmetic result, late combined with other medications.Methods: 20 patients were treated by fillet flap technique. Included in the study were huge, sessile, recurrent keloids. Pedunculated and small (&lt;1 cm) keloids were excluded.Results: All cases, except one flap survived completely with good primary healing. All patients were women and developed their lesions after cosmetic earlobe piercing. The lesions were unilateral in 16 (80%) patients and bilateral in four (20%) patients. After 1 year, major response was observed in fifteen cases (75%) and moderate response in four cases (20%); one case had a relapse 10 months after the surgery.Conclusions: Many methods of coverage of defect after surgical excision have been described but each has its own disadvantages. So, fillet flap technique covers the defect and gives very good cosmetic outcome.Fillet flap method of ear keloid repair and its cosmetic outcome: our experience

Easing the Excision of Earlobe Keloid.

Earlobe keloids are commonly encountered in this era where ear piercing is routine in various traditions. Various medical and surgical methods have been tried for its management. Surgically, fillet flap surgery has better acceptability worldwide. Various difficulties are faced during keloid excision, and we hereby describe few innovative modifications (use of needle, hydrodissection, pressure dressing, bolster button) using cost-effective and simple materials (needles, dynaplast, buttons) to ease the excision of keloids. These have easy adaptability and also reduce the recurrence rate of earlobe keloids.

Giant relapsing earlobe keloid – Successful combined treatment by surgery and pressure earring

Giant relapsing earlobe keloid – Successful combined treatment by surgery and pressure earring

Massive ear keloids: Natural history, evaluation of risk factors and recommendation for preventive measures – A retrospective case series

Keloid disorder (KD) is an inherited wound healing ailment, frequently seen among Africans /African Americans and Asians. Genetics of this disorder continues to be obscure and poorly understood. Clinical manifestation of KD is quite variable and very diverse, spanning from individuals with one or very few small keloidal lesions, to those with numerous and very large lesions covering large portion of their skin. Ears are common locations for development of keloids. Ear piercing is by far the leading triggering factor for ear keloid formation in genetically predisposed individuals. Although there are numerous publications about ear and earlobe keloids, there is a void in medical literature about massive ear keloids. This paper focuses on the natural history of massive ear keloids and risk factors that lead to formation of these life-changing and debilitating tumors and recommendations for prevention.

Treatment of earlobe keloids with intralesional photodynamic therapy

Treatment of earlobe keloids with intralesional photodynamic therapy

Evaluation of Treatment of Ear Lobe Keloid with Triamcinolone Injection and Surgical Excision

The study includes 42 consecutive patients with 68 ear lobe keloids. Patients underwent local infiltration of triamcinolone acetonide (TCN) at concentrations of 40mg/ml (Group 1) and 20 mg/ml (Group 2). Different volume of TCN infiltrate according to the size of the lesion. Treatment consisted of three monthly injections before surgery, excision of keloid in the fourth month and perioperative infiltration, followed by two more infiltration of TCN within two months. Post-treatment follow-up of patients was done for12 months. RESULTS: TCN at concentrations of 20mg/ml and 40mg/ml were effective for the treatment of keloids along with surgical excision,no difference between the groups (p = 0.73). CONCLUSION: The combination of infiltration of TCN monthly (1.2mg to 2.0mg per mm 3 ) and surgical

Expression Profile of Long Noncoding RNAs in Human Earlobe Keloids: A Microarray Analysis.

Background. Long noncoding RNAs (lncRNAs) play key roles in a wide range of biological processes and their deregulation results in human disease, including keloids. Earlobe keloid is a type of pathological skin scar, and the molecular pathogenesis of this disease remains largely unknown. Methods. In this study, microarray analysis was used to determine the expression profiles of lncRNAs and mRNAs between 3 pairs of earlobe keloid and normal specimens. Gene Ontology (GO) categories and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed to identify the main functions of the differentially expressed genes and earlobe keloid-related pathways. Results. A total of 2068 lncRNAs and 1511 mRNAs were differentially expressed between earlobe keloid and normal tissues. Among them, 1290 lncRNAs and 1092 mRNAs were upregulated, and 778 lncRNAs and 419 mRNAs were downregulated. Pathway analysis revealed that 24 pathways were correlated to the upregulated transcripts, while 11 pathways were associated with the downregulated transcripts. Conclusion. We characterized the expression profiles of lncRNA and mRNA in earlobe keloids and suggest that lncRNAs may serve as diagnostic biomarkers for the therapy of earlobe keloid.

Association of Surgery and Pulsed Dye Laser for the Treatment of an Ear Keloid: A Case Report

Background and Objective A keloidal scar is a benign hyperproliferation of dermal collagen resulting from abnormal healing. The ear is probably the most frequent interested area and these kind of keloids are responsible for cosmetic disfigurement. Numerous treatments have been utilized for keloids. Surgery is generally not indicated due to the high risk of recurrence while laser technologies have been tested to either prevent or treat hypertrophic scars. The association between laser and surgery was poorly reported in literature. In one case of ear keloid we decided to associate surgery and Pulsed-Dye laser. Materials and Methods We treated a female patient affected by an earlobe keloid with a surgical excision and subsequent pulsed Dye laser treatment. Results The aesthetic result was good and no signs of recurrence was observed. Conclusion We believe that the association between surgery and Pulsed-Dye laser can be useful to treat keloids with a low risk of recurrence.

Keloidectomy with core fillet flap and intralesional verapamil injection for recurrent earlobe keloids.

Earlobe keloids are usually recalcitrant to treatment and have a high rate of recurrence. Verapamil is a calcium channel antagonist that has been shown to inhibit the synthesis/secretion of extracellular matrix molecules and increase collagenase. This prospective study was designed to evaluate the results of treatment of recurrent earlobe keloids using keloidectomy with core fillet flap and intralesional verapamil injection. Nineteen keloids in 16 patients were treated using this technique with intralesional verapamil injection given intraoperatively, then every 2 weeks for 3 months, with postoperative follow-up for 18 months. Fourteen patients completed the study. Ten patients (71.4%) showed response to treatment. Four (28.6%) cases showed recurrence, two (14.2%) at the wound bed and another two (14. 2%) at the incision line. Eighty percent of responders were highly satisfied with their treatment. Keloidectomy with core fillet flap and intralesional verapamil injection is a reliable and cost-effective method in the treatment of recurrent earlobe keloids with a low rate of recurrence and high patient satisfaction.

Unusually giant and aggressive earlobe keloids – Two clinical reports

Earlobe keloids are benign, fibrous proliferations that show high rate of recurrence. Traumas to the earlobe such as ear piercing, burns or surgical interventions are the cause. Keloids are always difficult to treat and pose a challenging situation and has a significant psychosocial impact. We are presenting two cases of giant earlobe keloids, unusual by virtue of its size and are the biggest earlobe keloids ever seen in our tertiary care center. Excessive itching or repeated traumas to the scar are key factors for aggressiveness of keloids.

Radiation Therapy Following Total Keloidectomy: A Retrospective Study over 11 Years.

BackgroundRadiotherapy treatment after keloidectomy is known to be an effective method for reducing the rate of recurrence. However, to date, the appropriate total radiation dose and fractionation have not yet been confirmed. The authors performed a retrospective analysis to identify the appropriate radiation dose and fractionation in post-keloidectomy radiotherapy.MethodsFrom May 2000 to February 2011, postoperative radiotherapy was performed on 39 lesions in 28 patients after total keloidectomy. The keloid lesions were confined to the ear lobes. Between May 2000 and May 2004, 14 keloids were treated with surgical excision, followed by a total radiation dose of 1,200 cGy in three fractions over four to five days (group 1). Between June 2004 to February 2011, 25 keloids were treated with surgical excision, followed by a total radiation dose of 1,500 cGy in three fractions over four to five days (group 2). Patients were given a survey asking them to report their experiences regarding reoperation, recurrence of symptoms, recurrence of the lesion, and satisfaction with the operation.ResultsOf the 28 patients who were treated, 20 underwent follow-up. Group 2 had more cases showing elevation with erythematous changes, whereas group 1 had more cases showing progressive stages of elevation than group 2. These differences were statistically significant. Moreover, a correlation was observed between the level of keloid elevation and the extent of symptoms.ConclusionsWe suggest 1,500 cGy of radiation in three fractions following keloidectomy for ear lobe keloids. A further randomized study is needed to assess the recurrence of keloids after radiotherapy.

Simple device to determine the pressure applied by pressure clips for the treatment of earlobe keloids.

Background:Keloids of the ear are common problems. Various treatment modalities are available for the treatment of ear keloids. Surgical excision with intralesional steroid injection along with compression therapy has the least recurrence rate. Various types of devices are available for pressure therapy. Pressure applied by these devices is uncontrolled and is associated with the risk of pressure necrosis. We describe here a simple and easy to use device to measure pressure applied by these clips for better outcome.Objectives:To devise a simple method to measure the pressure applied by various pressure clips used in ear keloid pressure therapy.Materials and Methods:By using a force sensitive resistor (FSR), the pressure applied gets converted into voltage using electrical wires, resistors, capacitors, converter, amplifier, diode, nine-volt (9V) cadmium battery and the voltage is measured using a multimeter. The measured voltage is then converted into pressure using pressure voltage graph that depicts the actual pressure applied by the pressure clip.Results:The pressure applied by different clips was variable. The spring clips were adjustable by slight variation in the design whereas the pressure applied by binder clips and magnet discs was not adjustable.Conclusion:The uncontrolled/suboptimal pressure applied by certain pressure clips can be monitored to provide optimal pressure therapy in ear keloid for better outcome.

Does ear keloid formation depend on the type of earrings or piercing jewellery?

The ear is one of the most common sites of keloid formation, usually associated with the wearing of earrings. However, although this is a small perforating lesion that is equal on both sides, keloids are bigger and more prevalent on the posterior surface. In this study, 141 keloids were evaluated, most of which were located on the posterior surface of the earlobe and caused by the piercing of the ear. Most of the earrings and piercing jewellery used had metallic backs. The more frequent occurrence of earlobe keloids on the posterior surface of the ear therefore may be associated with the exacerbation of local neurogenic inflammation caused by the metallic backs.

Assesment of the treatment of earlobe keloids with triamcinolone injections, surgical resection, and local pressure.

To evaluate the combined treatment of ear lobe keloids. We studied 46 consecutive patients with 81 ear lobe keloids. Patients underwent local infiltration of triamcinolone acetonide (TCN) at concentrations of 40 mg/ml (Group 1), 20 mg/ml (Group 2) and 10mg/ml (Group 3). The volume of TCN infiltrate varied according to the size of the lesion. Treatment consisted of three monthly injections before surgery, excision of keloid in the fourth month and perioperative infiltration, followed by two more leaks TCN within two months. Patients used earrings pressure on the scar after operation for four months. The pressure exerted by earrings in the ear lobe was measured electronically. Post-treatment follow-up of patients was 24 months. TCN at concentrations of 20mg/ml and 40 mg/ml were effective for the treatment of keloids, no difference between the groups (p = 0.58). However, patients in which TCN was infiltrated the 10mg/ml had poor involution of keloid and the study of this group was stopped. the combination of infiltration TCN month to 20 mg/mL (1.2mg to 2.0mg per mm3 TCN injury), surgical excision and pressure application device is effective for treatment of keloid ear lobe.