What is the best treatment approach for an 8-month-old infant with a keloid formation at the site of an ear piercing?

Management of Keloid from Ear Piercing in an 8-Month-Old Infant

For an 8-month-old infant with a keloid from ear piercing, immediate referral to a pediatric plastic surgeon or pediatric otolaryngologist is essential, as surgical intervention in this age group requires specialized expertise and keloid management in infants presents unique challenges that demand subspecialty care.

Immediate Assessment and Referral

• First, confirm this is truly a keloid and not an infection or embedded earring, as infections are far more common than keloids in the first months after piercing and require different management 1, 2.
• Check for signs of infection including warmth, tenderness, purulent drainage, or systemic symptoms, as these would require antibiotic therapy before addressing keloid formation 2.
• Remove the earring immediately to prevent further trauma and embedding, which can worsen keloid formation 1, 2.

Subspecialty Referral is Mandatory

• Infants with keloid formation require referral to a pediatric plastic surgeon who has completed specialized training in pediatric plastic surgery and craniofacial surgery 1.
• The American Academy of Pediatrics guidelines emphasize that the outcome is uncertain whenever there is trauma to the skin resulting in scar, particularly in patients with keloid formation 1.
• Pediatric plastic surgeons are specifically trained to manage large cutaneous lesions and tissue reconstruction in infants, which is critical for optimal cosmetic outcomes 1.

Why Subspecialty Care is Critical in This Age Group

• Keloid treatment in an 8-month-old is fundamentally different from adolescent or adult management because:
  • Surgical excision techniques must account for ongoing ear growth and development
  • Anesthesia considerations are more complex in infants
  • Post-operative adjuvant therapies (pressure devices, silicone gel, steroid injections) require modification for infant anatomy and compliance 3, 4, 5

Treatment Options (To Be Determined by Specialist)

The pediatric plastic surgeon will likely consider:

• Conservative management first may be appropriate given the infant's age, as some lesions may stabilize or improve with observation alone.
• Intralesional corticosteroid injection is a common first-line treatment for keloids, though application in an 8-month-old requires careful dosing and technique 6.
• Surgical excision combined with adjuvant therapy (pressure therapy, topical silicone gel, or intralesional steroids) has shown effectiveness in older patients, but timing and technique must be adapted for infants 3, 4, 7.
• Pressure therapy using custom-made devices can be effective but requires devices specifically designed for infant ear anatomy to prevent pressure sores 3, 5.

Critical Counseling Points for Parents

• Inform the family that keloid treatment is challenging and recurrence rates are significant even with optimal management 4, 6, 7.
• Prevention is the best strategy: This infant should avoid any future body modifications that puncture the skin, and siblings or family members with keloid history should be counseled against ear piercing 1.
• If repiercing is ever considered in the future, it should be avoided entirely given the documented keloid formation, as the outcome of any future skin trauma is uncertain 1.

Common Pitfalls to Avoid

• Do not attempt home remedies or over-the-counter treatments without specialist guidance, as inappropriate management can worsen keloid formation.
• Do not delay referral thinking the keloid will resolve spontaneously—early specialist evaluation allows for optimal timing of intervention.
• Do not confuse keloid with hypertrophic scar or infection, as these require different management approaches 2, 6.