What are the treatment options for a keloid scar on the earlobe?

Treatment Options for Earlobe Keloid Scars

The most effective treatment for earlobe keloids is a combination of surgical excision followed by immediate intralesional triamcinolone acetonide (TAC) injection, with additional TAC injections every 3-4 weeks to prevent recurrence. 1

First-Line Treatment Approach

Intralesional Corticosteroid Therapy

• For small keloids (<2 cm):
  • Intralesional TAC (10-40 mg/mL) every 3-4 weeks 1
  • Continue for at least 3 sessions before evaluating response
  • If inadequate response, add cryotherapy to the regimen

Combination Therapy

• For larger or resistant keloids (>2 cm):
  • Combination of TAC with 5-fluorouracil (5-FU) or pentoxifylline (PTX) 1
  • Alternative: TAC + cryotherapy
  • Cryotherapy protocol: 15-20 seconds freeze time followed by TAC injection 1
  • Repeat every 3-4 weeks

Surgical Options

Keloid Fillet Flap Technique

• Surgical approach specifically designed for earlobe keloids 2
• Procedure:
  • Skin over keloid is dissected as a flap
  • Keloid mass completely removed
  • Flap trimmed and closed without subcutaneous sutures
  • Performed under local anesthesia
• Benefits: Complete removal with good cosmetic outcome
• Drawback: 44% recurrence rate when used alone 2

Surgical Excision with Adjuvant Therapy

• Extralesional excision followed by immediate postoperative radiotherapy has shown 91.2% control rate at 1 year and 79.4% at 5 years 3
• Surgical excision should always be combined with adjuvant therapy to prevent recurrence

Additional Treatment Options

Silicone-Based Products

• Silicone gel sheeting or topical silicone gel 4
• Mechanism: Hydration and occlusion of the scar
• Can improve texture, color, and height of keloid scars
• Best used as adjunctive therapy rather than primary treatment

Novel Approaches

• Non-cross-linked hyaluronic acid combined with cortisone therapy 5
  • Has shown complete resolution in case reports
  • May be considered for recalcitrant cases

Pressure Therapy

• Custom-made pressure earrings
• Must deliver 24-30 mmHg pressure
• Should be worn for at least 12-16 hours daily
• Most effective when combined with other treatments

Treatment Algorithm

1. For new or small earlobe keloids:

   • Begin with intralesional TAC (10-40 mg/mL) every 3-4 weeks
   • Consider adding silicone gel sheeting between injections
   • Evaluate after 3 sessions

2. For resistant small keloids:

   • Add cryotherapy before TAC injections
   • Consider pressure therapy as adjunct

3. For large or recurrent keloids:

   • Surgical excision with immediate TAC injection
   • Follow with regular TAC injections every 3-4 weeks for at least 6 months
   • Consider radiotherapy for high-risk cases

Important Considerations

• Earlobe keloids have a high recurrence rate (40-100%) when treated with surgery alone
• Combination therapy is always superior to monotherapy
• Darker skin types and family history of keloids increase recurrence risk 1
• Patients should be counseled about realistic expectations and potential need for multiple treatment modalities

Prevention

• Individuals with history of keloids should avoid ear piercing or other body modifications 6, 1
• If piercing is performed, immediate prophylactic measures (pressure, silicone, or TAC) should be considered