Earlobe keloids are a common problem in skin of color patients that can be frustrating to both patients and physicians.
An article in the March issue of Dermatologic Surgery (2012;38:406-12) described a new morphologic classification for earlobe keloids and a surgical approach for their management.
Although surgical management is important for resistant, recurrent keloids, I often use a five-step nonsurgical regimen for treating earlobe keloids.
Set expectations and counsel the patient. Keloids can recur.
Avoid triggers. Make sure there is no underlying contact dermatitis from nickel or other metal alloys that can cause inflammation contributing to the scar tissue formation.
Intralesional steroids. Consider starting with Kenalog 20 mg/cc and increase by 10 mg/cc at each 4 week visit for optimal benefit. Often times, I use very gentle subscision in the tough scar tissue with a 26 gauge ½ inch needle to open up channels for the Kenalog to penetrate.
Compression therapy. Clip on compression earrings or a medical compression device called a Zimmer splint, which has two discs that clip on the ear placing pressure on both sides of the lobe.
Use silicone based gels and instruct patients to massage the area several times daily.
Keloids can be a frustrating and aesthetically unacceptable problem. Surgical methods are useful, including keloidectomy, core extirpation, or a combination.
However, in-office and home-based remedies both decrease recurrence rates and improve the size and thickness of keloids so that surgery can be reserved as an adjunct treatment by removing redundant skin rather than thick keloidal scar tissue.
- Lily Talakoub, M.D.
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