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A primary protocol
for the management of ear keloids: results of excision combined with
intraoperative and postoperative steroid injections. Plast Reconstr
Surg.2007 Oct;120(5):1395-400.
BACKGROUND:
Keloids of the ear are a challenging problem, with many treatment
modalities advocated. The primary determinant in choosing a
treatment protocol should be a low recurrence rate. Most reports in
the literature suffer from small numbers of patients and inadequate
follow-up. METHODS: This study presents a retrospective analysis of
64 patients representing 92 ear keloids treated between 1982 and
1997. The treatment protocol consisted of excision with an
intraoperative and two postoperative steroid injections. All
patients were treated by a single physician. Long-term follow-up was
obtained at a minimum of 5 years. RESULTS: Protocol success was
achieved in 74 of 92 keloids (80 percent) excised. Prior excision of
the keloid was significantly associated with protocol failure (p =
0.0068). Keloid recurrence was seen in 10 of 43 (23 percent).
Statistically significant differences were noted in keloids that had
undergone prior excision as compared with those presenting for
initial treatment. These differences included growth rate (p =
0.0026), protocol failure (p = 0.0149), and total postoperative
steroid injections administered (p = 0.0104). CONCLUSIONS: The
primary protocol presented for the treatment of ear keloids produces
durable results, with an acceptably low recurrence rate.
Stratification of keloids based on an assessment of aggressiveness
may allow for a more informed choice in their optimal treatment.
Application of
mitomycin-C for head and neck keloids. Otolaryngol Head Neck Surg.
2006 Dec;135(6):946-50.
Keloids of
the head and neck are a relatively common entity in darker-skinned
races, occurring in 5%-15% of skin wounds. Keloids are fibrotic
lesions that are a result of an abnormal wound-healing process that
lacks control of the mechanisms that regulate tissue repair and
regeneration. The proliferation of normal tissue-healing processes
results in scarring that enlarges well beyond the original wound
margins. Many treatment modalities for keloids have been tried with
variable amounts of success. Surgical excision, compressive therapy,
silicon dressings, corticosteroid injections, radiation, cryotherapy,
interferon therapy, and laser therapy have all been used alone or in
combination. Despite this wide range of available treatments,
recurrence rates typically remain in the 50%-70% range. In this
study, we present our results in a series of 10 patients who were
treated with surgical excision of head and neck keloids and the
application of topical mitomycin-C. Mitomycin-C is a
chemotherapeutic agent that inhibits DNA synthesis and fibroblast
proliferation. It has been used in ophthalmologic procedures and
airway surgery to decrease scar formation. In these 10 patients, we
combined surgical excision of keloids with the application of
topical mitomycin-C. The patients were then followed postoperatively
for recurrence (range, 7-14 months). We have found topical
application of mitomycin-C to be an effective therapy for prevention
of keloid recurrence in the head and neck, with a success rate of
90% as reported in this series.
Relationship
between age of ear piercing and keloid formation. Pediatrics.
2005 May;115(5):1312-4.
OBJECTIVE:
Keloids occur commonly after trauma to the skin, with ear piercing
being a well-known inciting event. We surveyed 32 patients with
keloids resulting from ear piercing, to examine a potential
relationship between age of piercing and keloid formation. METHODS:
A total of 32 consecutive patients completed a survey about
ear-piercing and keloid formation. Fisher's exact test was used for
data analysis. RESULTS: Fifty percent (n = 16) of surveyed patients
developed a keloid after their first piercing. Twenty surveyed
patients developed keloids with subsequent piercings. Those who had
piercings at > or =11 years of age were more likely to develop
keloids (80%) than were those who had piercings at <11 years of
age (23.5%). CONCLUSIONS: Keloids are more likely to develop when
ears are pierced after age 11 than before age 11. This observation
holds true for patients with a family history of keloids. Given the
difficulty and cost of treating keloids, prevention remains the best
approach. Patients with a family history of keloids should consider
not having their ears pierced. If this is not an option, then
piercing during early childhood, rather than later childhood, may be
advisable. Primary care physicians and pediatricians should educate
children and their parents about the risk of keloid formation.
Keloid of the
earlobe after ear piercing. Not only a surgical problem.
Chirurg.2002 May;73(5):514-6.
Earlobe
keloids are benign, fibrous proliferations that show a high rate of
recurrence of up to 80% following surgical excision. Traumas to the
earlobe such as ear piercing, burns or surgical interventions are
important in the pathogenesis of the disease. In addition to
surgical keloid excision and reconstruction of the earlobe, several
adjuvant therapeutic concepts have been described to prevent
recurrence. Here we present the case of a female patient who
suffered from severe bilateral keloid development after piercing of
both ears. The report gives an overview of the relevant therapeutic
concepts in the treatment of earlobe keloids and their possible
complications. In addition, the question of written informed consent
before ear piercing is discussed.
Keloid of the
external ear. Ugeskr Laeger.1994 Jul 4;156(27):4025-8.
Keloid
formation is an unpredictable complication to normal scar tissue
development. The etiology is unknown, although an individual
predisposition may be present. There is a regional propensity for
the head, neck and upper torso. The treatment is difficult, and this
should be taken into consideration when cosmetic procedures are
being contemplated. This type of surgery should be avoided in
individuals with previous keloid formation. Four cases of keloid
formation, two after ear lobe piercing and two after otoplasty are
presented and a satisfying outcome of surgical revision with ensuing
steroid medication is reported.
Earlobe keloids.
Am Fam Physician.1994 Jun;49(8):1835-41.
Earlobe
keloids are a challenging management problem. These benign, fibrous
proliferations develop in predisposed persons at sites of cutaneous
injury or as the result of ear piercing, burns or surgical
procedures. Earlobe keloids usually appear as shiny, smooth,
globular growths on one or both sides of the earlobe. Patients
frequently complain of cosmetic embarrassment, but also may report
pruritus, pain or paresthesias. No single therapeutic modality is
best. The location, size, depth and duration of the earlobe keloid
influence the choice of therapy. Surgical treatment for earlobe
keloids generally includes core excision with low-tension wound
closure, and shave excision. Surgical repair with corticosteroid
injections and postoperative pressure on the incision site usually
provide good cosmetic results. Patients must be counseled about
recurrence, palpable postoperative nodules and the need for close
monitoring.
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