A Comparison of the Effectiveness of Triamcinolone and Radiation Therapy for Ear Keloids after Surgical Excision: A Systematic Review and Meta-Analysis

Shin, Jin Yong; Lee, Jinwon; Roh, Si-Gyun; Lee, Nae-Ho; Yang, Kyung‐Moo

doi:10.1097/prs.0000000000002165

Cited by 48 publications

(58 citation statements)

References 49 publications

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“…Recently-advocated approach of surgery in combination with adjuvant radiation therapy 7, 9 , although it may yield to a lower keloid recurrence rate, it is by no means curative and still results in recurrence of keloids. It also exposes all patients to potentially grave adverse effects of radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

“…However, they do believe and I have shared plenty of patients to validate that ear keloids can be effectively removed in a sustainable, cosmetically acceptable way without necessarily (and in fact rarely) resorting to radiation therapy adjunctively. This sort of response is well-documented in the literature they just don't happen to be references this author cites: Triamcinolone after surgery as effective as radiation therapy (and both can be effective) at preventing recurrence 1 Pressure clips after surgery can prevent recurrence (this is technique used by my colleagues in Plastic Surgery to good effect) 2 There are countless other references of success using surgery with acceptable risk-benefit profiles.…”

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confidence: 96%

“…Triamcinolone after surgery as effective as radiation therapy (and both can be effective) at preventing recurrence 1 …”

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confidence: 99%

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Massive ear keloids: Natural history, evaluation of risk factors and recommendation for preventive measures – A retrospective case series

Tirgan¹

2017

F1000Res

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Keloid disorder (KD) is an inherited wound healing ailment, frequently seen among Africans /African Americans and Asians. Genetics of this disorder continues to be obscure and poorly understood. Clinical manifestation of KD is quite variable and very diverse, spanning from individuals with one or very few small keloidal lesions, to those with numerous and very large lesions covering large portion of their skin. Ears are common locations for development of keloids. Ear piercing is by far the leading triggering factor for ear keloid formation in genetically predisposed individuals. Although there are numerous publications about ear and earlobe keloids, there is a void in medical literature about massive ear keloids. This paper focuses on the natural history of massive ear keloids and risk factors that lead to formation of these life-changing and debilitating tumors and recommendations for prevention.

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Section: Discussionmentioning

confidence: 99%

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confidence: 96%

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Massive ear keloids: Natural history, evaluation of risk factors and recommendation for preventive measures – A retrospective case series

Tirgan¹

2017

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“…In the meta-analysis published in 2016, triamcinolone injection and radiation were both considered outstanding treatments for keloids without significant difference. [7] However, some of the patients relapsed after triamcinolone injections were then treated with adjuvant radiation therapy. Other methods such as laser treatment, silicone gel, pressure therapy, or 5-FU were either proven ineffective or still lack of strong clinical evidence.…”

Section: Introductionmentioning

confidence: 99%

Radiation Therapy in Keloids Treatment

Yang

et al. 2017

Chinese Medical Journal

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Objective:Radiation therapy combined with surgical excision was considered as one of the most effective treatment plans for keloid lesions. However, there was no unanimity found over present literatures regarding the issue on optimized treatment strategy for keloids. We here provide a comprehensive review over this issue and emphasize on the influencing factors.Data Sources:The data analyzed in this review were searched from articles included in PubMed and EMBASE databases.Study Selection:The original articles and critical reviews discussing the application of radiation therapy in keloids treatment were selected for this review.Results:The application of radiation therapy has transitioned from simple superficial X-ray irradiation to brachytherapy. Furthermore, several factors including radiation type, dose, fraction, interval, and complications were reviewed, and the results revealed that these factors were significant toward clinical outcome at various levels.Conclusions:Both past and present evidence support the idea that combination therapy of radiation and surgical therapy is safe and feasible. However, the optimization of treatment strategy was based on different radiation types and should take dose, fractions, interval, and complications into consideration, which will then decrease the rate of recurrence and increase the level of satisfaction.

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“…A recent meta‐analysis of 25 studies showed a recurrence rate of 15.4% (95% CI, 9.4–24.1%) for surgical excision followed by intralesional injection of triamcinolone vs. 14.0% (95% CI, 9.6–19.9%) for surgical excision followed by radiation therapy . This stands in contrast to surgical excision alone, which has a high recurrence rate between 50% and 100% .…”

Section: Introductionmentioning

confidence: 99%

A multimodal therapeutic approach improves the clinical outcome of auricular keloid patients

et al. 2019

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Objective We retrospectively studied the efficacy of personalized therapy with surgical resection plus prophylactic management of postsurgical auricular keloids by intralesional injection of betamethasone and local pressure therapy using magnets in patients with auricular keloids. Methods Surgical excision was performed in all patients, and surgical techniques including fusiform excision of the keloid scar, core excision of the keloid scar followed by flap repair, and scar graft were chosen. Results A total of 85 patients with 98 auricular keloids were eligible. Seventy‐two (74%) patients had primary auricular keloids, and 13 patients had recurrent keloids after surgical excision. Keloids, were located in the helix in 28 (32.9%) cases, in the earlobe in 45 (52.9%) cases, and in the entire auricle in 12 (14.1%) cases. The size of auricular keloids ranged from 10 to 35 mm. Surgical resection was uneventful in all cases. Twenty‐one (21.4%) patients received fusiform excision, 47 (47.9%) patients underwent core excision and flap repair, and 30 (30.6%) patients received skin grafts. The patients were followed up for median duration of 1 year (range: 12–24 months). The cure rate was 87.2%, and the recurrence rate was 12.8%. Conclusion A personalized surgical approach based on the characteristics of auricular keloids in each patient and a multimodal therapeutic regimen including surgical excision, glucocorticoid blockade, and intralesional injection of glucocorticoids and pressure therapy improve the cure rate and reduce the recurrence rate of auricular keloids.

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A Comparison of the Effectiveness of Triamcinolone and Radiation Therapy for Ear Keloids after Surgical Excision: A Systematic Review and Meta-Analysis

Abstract: Although a large-scale, randomized study is required for confirmation, both triamcinolone and radiation therapy provided outstanding treatment for ear keloids after surgical excision without a significant difference between the two treatments.

Cited by 48 publications

References 49 publications

Massive ear keloids: Natural history, evaluation of risk factors and recommendation for preventive measures – A retrospective case series

Massive ear keloids: Natural history, evaluation of risk factors and recommendation for preventive measures – A retrospective case series

Radiation Therapy in Keloids Treatment

A multimodal therapeutic approach improves the clinical outcome of auricular keloid patients

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