A Novel Treatment of Auricular Keloid
Keywords:
Cosmetic debulking, Ear piercing, Ear keloids , Intralesional injection , Triamcinolone , MethotrexateAbstract
Background: Auricular keloids are not uncommon skin problem that is observed among young females following ear piercing. They can occur in earlobes as well as in the skin and cartilage higher on the ear. Different types of therapy are available, but are often followed by relapse.
Objective: To assess the efficacy and safety of the intralesional injection of combination of steroid and methotrexate, followed by shaving.
Methods: All patients gave a history of ear piercing that was followed by the appearance of keloid. Full data from the participants regarding the demographic and clinical characteristics were described. After intralesional injection of keloid with combination of triamcinolone (20 mg in 0.5ml) and (10 mg in one ml) methotrexate, shaving of the lesion with a scalpel and a simple diathermy needle was performed. Then patients were followed after 3-4 weeks, and the combination injection was also done again. Follow-up was carried on regular basis for one year.
Results: Nine females were treated by this new therapeutic regime; their ages ranged from 18 to 33 years, with a mean of 27 years. Seven patients had a single keloid on one side, while two patients had a single lesion on both ears. All patients had complete clearance of keloids without complications, like infection or new keloid formation. No relapses were recorded within a one-year follow-up period.
Conclusion: This novel modality shows excellent cosmetic appearance with no recurrence during a one-year follow-up.
References
1. Sharquie K, Noaimi A, Al-Karhi M. Debulking of keloid combined with intralesional injection of methotrexate and triamcinolone versus intralesional injection of methotrexate and triamcinolone. J Clin Dermatol Ther. 2014;1(3):8-21.
2. Gauglitz G, Kunte C. Recommendations for the prevention and therapy of hypertrophic scars and keloids. Der Hautarzt. 2011;62:337-46.
3. Kim H-D, Hwang S-M, Lim K-R, Jung Y-H, Ahn S-M, Song JK. Recurrent auricular keloids during pregnancy. Arch Plast Surg. 2013;40(01):70-2.
4. Donkor P. Head and neck keloid: treatment by core excision and delayed intralesional injection of steroid. J Oral Maxillofac Surg. 2007;65(7):1292-6.
5. Domenico P, Giuliana C, Daniele B, Bruno B, Alessandro G, Fabrizio M, et al. Ear keloids: An innovative 3‐steps combined treatment. Skin Res Techn. 2023;29(11):e13506.
6. Al-Ani RM, Kubaisi TA. Unilateral auricular multiple trichoepitheliomas: a case report and review of literature. Egyptian J Otolaryngol. 2023;39(1):63.
7. Chuangsuwanich A, Gunjittisomrarn S. The efficacy of 5% imiquimod cream in the prevention of recurrence of excised keloids. Journal-Medical Association Of Thailand. 2007;90(7):1363.
8. Berman B, Perez OA, Konda S, Kohut BE, Viera MH, Delgado S, et al. A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg. 2007;33(11):1291-303.
9. Sullivan T, Smith J, Kermode J, Mclver E, Courtemanche D. Rating the burn scar. J Burn Care Rehabil. 1990;11(3):256-60.
10. Yıldız E. Triple treatment in ear keloids: Comparison of post-excisional intralesional steroid and platelet-rich plasma treatment. Am J Otolaryngol. 2021;42(3):102935.
11. Tran JV, Lultschik SD, Ho JS, Sapra S, Dong K, Gusic K. Concomitant therapy of surgical shave excision and intralesional injections for ear keloids: Early results from a retrospective cohort study. Scars Burns Heal. 2022;8:20595131221098531.
12. Li H, Song T. 3d printed custom made pressure clips for ear keloid treatment after surgical excision. Am J Otolaryngol. 2020;41(4):102516.
13. Han X-M, Jiang S-Q, Hu C-X, Du M, Zhao L. Triple Surgical Technique for the Repair of Auricular Keloids: Achieving Perfect Restoration of the Ear Contour. Aesthet Plast Surg. 2024:1-9.
14. Mane BS, Gavali RM. Our Experience at Tertiary Medical College—Intralesional Injection of Triamcinolone Acetonide Versus Injection Verapamil Following Keloidectomy with Fillet Flap in Auricular Keloids. Indian J Otolaryngol Head Neck Surg. 2024;76(1):237-44.
15. Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids. Plast Reconst Surg. 2010;125(2):557-68.
16. Park TH, Seo SW, Kim JK, Chang CH. Earlobe keloids: classification according to gross morphology determines proper surgical approach. Dermatol Surg. 2012;38(3):406-12.
17. Mohammadi AA, Kardeh S, Motazedian GR, Soheil S. Management of ear keloids using surgical excision combined with postoperative steroid injections. World J Plast Surg. 2019;8(3):338.
18. Hung Y-T, Lin S-M, Tzeng I-S, Ng CY. Optimizing surgical outcome of auricular keloid with a novel multimodal approach. Scientific Rep. 2022;12(1):3533.
19. Bangalore Narayanaswamy V, HM S, HN U, HK N. Intralesional steroid injection in keloid ear-a prospective observational study. Egyptian J Otolaryngol. 2025;41(1):4.
20. Shaheen A, Khaddam J, Kesh F. Risk factors of keloids in Syrians. BMC Dermatol. 2016;16:1-11.
21. Chaidas K, Fotiadis G, Katotomichelakis M. Large Bilateral Auricular Keloid Formation Secondary to Prolonged Facial Mask Use During COVID-19 Pandemic. Ear Nose Throat J. 2024:01455613241254159.
22. Viera MH, Amini S, Valins W, Berman B. Innovative therapies in the treatment of keloids and hypertrophic scars. J Clin Aesthet Dermatol. 2010;3(5):20.
23. Hou J, Liu C. The Combination of Tunnel Shaped Excision with Radiotherapy and Injection of Type A Botulinum Toxin in the Treatment of Auricular Keloids. Aesthet Plast Surg. 2025;1:1-7.
24. Lu Z, Zhu D, Yang Y, Kou H, Li X, Zhang J. Assessment of the efficacy and safety of auricular keloids excision followed by 5-aminolevulinic acid photodynamic therapy. Photodiag Photodynamic Ther. 2024;50:104335.
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