Auricular keloid management in Asian skin: Clinical outcome of intralesional excision and postoperative triamcinolone acetonide intralesional injection

Abstract

Background Various options such as surgical excision, steroid injection, cryotherapy, pressure dressing, and radiation therapy are available for the treatment of auricular keloids. In particular, auricular keloid therapy using surgical excision is important because recurrence rates are low compared with keloids occurring in other parts of the body. Aims We aimed to evaluate the clinical outcomes of intralesional excision followed by postoperative triamcinolone acetonide intralesional injection (TA ILI) as auricular keloid treatments. Methods We conducted a surgery records and chart review of patients who underwent auricular keloid treatment with intralesional excision and TA ILI. Reduction in height and volume was assessed by two blinded dermatologists. We also analyzed the recurrence rate over a 2‐year period and evaluated patient satisfaction using an 11‐point questionnaire (0‐10). Results Eighteen Korean patients (2 males and 16 females) with a mean age of 26.5 years and a total of 20 lesions were evaluated. Lesion types by descending frequency were lobular (n = 10, 50%), anterior/posterior button (n = 3, 15%), wrap‐around (n = 3, 15%), dumbbell (n = 2, 10%), and sessile (n = 2, 10%). The total recurrence rate was 5% (1/20) within the 24‐month follow‐up period. Significant reduction (> 50%) in height and volume was achieved in 95% of patients. No serious or persistent adverse events were reported during the follow‐up period. Conclusion We confirmed that TA ILI after intralesional excision can be effective for auricular keloid management. A low recurrence rate similar to that of postoperative radiation therapy was obtained with an effective surgical procedure and minimal postoperative treatment.

Keloid Intralesional Excision Reduces Recurrence: A Meta-analytic Study of the Available Literature on 608 Keloids

“…Only four studies included information on patients' race/ethnicity. [19][20][21]25 Average time to follow-up was 19.2 months (range 6-35 months). Shorter time to follow-up was not associated with lower recurrence rate (P = 0.63).…”

“…After excluding statistical outliers by assessing studentized residuals, a total of 22 studies were included in the meta-analysis, totaling 608 keloids. 8,14–34 (In cases where one patient had multiple keloids treated, each keloid was considered a unique case.) Additional therapies used are summarized in Table 1.…”

RUNX3 mediates keloid fibroblast proliferation through deacetylation of EZH2 by SIRT1

“…Keloid tissues and surrounding normal skin tissues were collected from 5 patients with keloid. The keloids were removed according to previous description [ 36 ]. This study was reviewed and approved by the ethics committee of Yanbian Hospital (Approval No: ybyy-2020–03,010).…”

A Triple Combination Therapy Using 2-mm Biopsy Punch for the Treatment of Multifocal Keloids

“…11,12 The surgical approach can be divided into core extirpation versus wedge excision for auricular keloids or complete excision versus intralesional excision for other locations except for ears. 11,13,14 In 2015, we reported 3 distinct collagen architectures of keloids based on the histomorphometric analysis performed in an Asian population. 15 Among 3 parts, proliferating core collagen, the innermost part of collagen architecture in keloids, was found to serve as a proliferating center of keloids and play a critical role in keloid growth and recurrence based on another prospective study performed in 2018.…”

“…11,12 The surgical approach can be divided into core extirpation versus wedge excision for auricular keloids or complete excision versus intralesional excision for other locations except for ears. 11,13,14…”