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

Abstract

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.

An Atlas of Lumps and Bumps: Part 15

“…A keloid represents an excessive response of the dermis to cutaneous injury (eg, secondary to acne, piercing, or surgery). 19 Rarely, a keloid may develop de novo without a previous noticeable injury to the skin. 8 It is a benign hyperproliferative growth of dense fibrous tissue and overabundant deposition of disorganized, thick, hyalinized collagen.…”

“…5 The peak incidence is between 10 and 30 years of age. 19 At times, affected patients may complain of pain and itching discomfort. 20 The condition can have significant social and psychological impacts that negatively affect a patient's quality of life.…”

Lack of efficacy of dupilumab in the treatment of keloid disorder

“…Further, we are highly experienced in treating skin disorders and know to clinically diagnose keloids and performed a biopsy that was compatible with keloids. 3 The areas were biopsied to rule out skin cancer, due to the large growths, as we usually do not biopsy atopic dermatitis lesions. Furthermore, reports such as Klumpar et al 4 report development of keloids in areas of trauma.…”

“…Although localized treatments may be appropriate for patients with early and limited stages of KD, patients with more advanced disease would benefit from systemic therapy. 3 In 2020, Diaz et al 4 reported a 53-year-old African American male with atopic dermatitis treated with dupilumab. This patient also had two exophytic nodules in his right popliteal fossa that were diagnosed as keloids.…”

Aesthetic reconstruction of retroauricular keloid: Creating a keystone flap from the mastoid‐helix area

“…Keloids are abnormal wound reactions, which develop from connective tissue as a result of skin trauma such as inflammation, burns, piercing or surgery in predisposed individuals . Auricular keloids are very troublesome to patients due to disfigurement .…”