Ear piercing: The sad story behind ear lobule Keloid

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Should supplemental antioxidant administration be avoided
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Ear piercing: The sad
story behind ear lobule
Keloid
Sir,
Keloids are among the diseases which are easy to diagnose but
difficult to treat. The term Keloid is derived from the Greek
word for crab claw.[1] Keloid formation is a result of deviation
of the normal healing process, which can be seen after surgical
procedures, trauma, insect bites or even vigorous scratching.
Some common sites for Keloid formation are chest,
shoulders, ear lobules, upper arms, and cheeks.[2] Keloids
on ear lobules are common in younger females than
males, because of the cosmetic piercing of the ear lobule.[3]
Ear lobule Keloids account for 2.5% of cases which are
usually secondary to ear piercing.[4] In India, it is even
seen in males due to religious ear lobule piercing which
is known as “Karna Vedha”, which is performed in early
infancy. However, considering the number of ear piercings
performed, incidence of Keloid formation is very less. This
may be explained by the inference of the study conducted
by Lane et al. which showed that the chance of Keloid
formation is less if ear piercing is performed before the age
of 11 years. They also found that the occurrence of Keloid
is more in patients with positive family history of Keloid.[5]
Keloids are uncommon over 65 years of age.[3]
Diagnosis of ear lobule Keloid is easier than the rest of the
body, where it has to be differentiated from hypertrophied
scar, which even though inappropriately large, remains
confined to the wound site. In contrast, the Keloid grows
well beyond the margins of injury.[1] They appear as pink to
brown colored rubbery, firm or fibrous nodule of variable
size at the site of ear piercing [Figure 1]. The differential
diagnosis of earlobe keloid include dermoid cyst, lipoma,
210
Figure 1: Clinical photograph of Keloid of ear lobule following
ear piercing
fibroma, and adnexal tumors. However, the history and
clinical examination is sufficient for the diagnosis in most
of the cases.
There is no definite treatment protocol described for
Keloids. Absence of a definitive treatment is due to
incomplete understanding of the pathogenesis of Keloid
formation. The irregular collagen architecture, and also the
increased ratio of type I to type III collagen is the primary
pathology in Keloids.[6]
Surgical excision of Keloids generally result in recurrence,
with recurrence rates ranging from 40% to 100%. Silicone
gel is used as an adjunct to Keloid excision and also as
prophylaxis to prevent abnormal scarring following elective
incisions in people with tendency or family history of Keloid
formation. It can be used as topical gel or impregnated
elastic sheet, which need to be used for at least 12 h a day.[1]
Medical therapies include intralesional injection of steroid
triamcinolone acetonide which is an easy and affordable
therapy with fairly good result [Figure 2]. Intralesional
5-flurouracil, interferon therapy and imiquimod therapy
are the other options. Tacrolimus is a newer addition to
the list.[3] Radiation therapy has been shown to effectively
reduce the recurrence rate of Keloids. It works by directly
damaging fibroblasts, which alters collagen structure and
organization.[1] Laser therapy with argon laser, carbon
dioxide laser, neodymium-doped yttrium aluminum garnet
are attempted without much improved results.[3]
Cryosurgery, intralesional antihistamines, colchicine,
methotrexate, cyclosporine, D-penicillamine, and relaxin
are among the other methods attempted.[1,3] However, none
of them show promising results.
International Journal of Health & Allied Sciences • Vol. 3 • Issue 3 • Jul-Sep 2014
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Letters to Editor
Address for correspondence:
Dr. Vadisha Srinivas Bhat,
Department of Otorhinolaryngology, K. S. Hegde Medical Academy,
Mangalore - 575 018, Karnataka, India.
E-mail: [email protected]
REFERENCES
1.
2.
3.
4.
5.
Figure 2: Clinical photograph of Keloid showing regression
in response to intralesional triamcinolone
To conclude, ear lobule Keloid is most unwanted happening
after cosmetic ear piercing. As the treatment of this disease
is yet to be standardized, prevention should be the option
whenever possible. Patients with a family history of Keloids
should avoid undergoing ear piercing. If at all piercing is
mandatory, it should be performed in early childhood.
6.
Davidson S, Aziz N, Rashid RM, Khachemoune A. A primary care
perspective on keloids. Medscape J Med 2009;11:18.
Alster TS, Tanzi EL. Hypertrophic scars and keloids: Etiology and
management. Am J Clin Dermatol 2003;4:235-43.
Kelly AP. Medical and surgical therapies for keloids. Dermatol Ther
2004;17:212-8.
Park TH, Seo SW, Kim JK, Chang CH. Outcomes of surgical excision
with pressure therapy using magnets and identification of risk factors
for recurrent keloids. Plast Reconstr Surg 2011;128:431-9.
Lane JE, Waller JL, Davis LS. Relationship between age of ear piercing
and keloid formation. Pediatrics 2005;115:1312-4.
Friedman DW, Boyd CD, Mackenzie JW, Norton P, Olson RM,
Deak SB. Regulation of collagen gene expression in keloids and
hypertrophic scars. J Surg Res 1993;55:214-22.
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Vadisha Srinivas Bhat
Department of Otorhinolaryngology, K. S. Hegde Medical
Academy, Mangalore, Karnataka, India
Website:
www.ijhas.in
DOI:
10.4103/2278-344X.138612
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