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

Abstract

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.

Observation of the clinical efficacy of isotope phosphorus‐32 dressing combined with diprospan and mucopolysaccharide polysulphate cream in the treatment of keloids

“…14 Studies have shown that repeated use of large doses of corticosteroids can worsen keloids. 15 Hirudoid, or mucopolysaccharide, ointment is a white ointment based on emulsion. It is less irritating to skin and can quickly penetrate deeper subcutaneous tissues.…”

Judicious management of pinna keloids: our experience with combination therapy

“…1 In a recent study evaluating multimodal approach to keloids, surgical excision followed by betamethasone injections and pressure therapy using custom made magnets achieved a cure rate of 87.2%. 12 According to Ogawa and colleagues, the dosage of radiotherapy for ear lobe is 10 Gray (Gy) in two fractions over two days, and the radiotherapy can start from first or second day after surgery. 13 In a recent study on 35 keloids managed with surgical excision followed by radiation therapy, seven recurred, giving a recurrence rate of 20%.…”

Individualized surgery combined with radiotherapy and triamcinolone acetonide injection for the treatment of auricular keloids

“…As a result, the treatment is greatly restricted. At present, there are many means of treatments for auricular keloids, but treatment effects were poor and recurrence rates were high [3,4]. It was reported that the recurrence rate of surgery alone was as high as 45-100%, and that of glucocorticoid injection alone in lesions was 9-50% [3,5].…”