Therapy of auricular keloids: review of different treatment modalities and proposal for a therapeutic algorithm

Abstract

Keloids are abnormal wound reactions of connective tissue. Auricular keloids can develop as a result of, e.g., otoplasty, ear piercing, or skin trauma. A wide variety of therapeutic options exists, including surgery as primary treatment. Furthermore, there are medical, physical, radiotherapeutic and experimental options. The present paper focuses on the different techniques including the therapeutic outcome and quality rating for each chosen pathway. In addition to the experience of the university hospitals, a thorough review of the literature was performed in order to update and compare today's therapeutic options. Surgical techniques are customized to the lesion's specific localization and extent. They may include revision of otoplasty. With medical treatment, established modalities such as steroid injection have to be distinguished from experimental methods like interferon, 5-FU, verapamil, imiquimod, or mitomycin C. Radiation is generally accepted to be effective, especially applied accompanying surgery, but needs to be restricted due to possible side effects. Physical therapy, e.g., pressure in a variety of application modalities, has gained a profound position in the therapy of auricular keloids. The success rates of the different treatment modalities vary markedly, and the number of patients per study is considerably low. Resuming the results, a periodic follow-up and good patients' compliance are mandatory to early realize and treat auricular keloids. However, studies are needed to evaluate accepted and experimental therapies including larger number of patients.

Strategic management of keloid disease in ethnic skin: a structured approach supported by the emerging literature

“…Historically, a number of treatment modalities such as cryotherapy, 23 interferon 24 and veramapril 25 have been utilized for treating KD, with inconsistent levels of success. However, more recent treatments such as lasers, 26 intralesional steroid injections, 27 silicone gel, 28 5-fluorouracil (FU), 29 radiotherapy, 30 bleomycin, 31 imiquimod, 32 photodynamic therapy (PDT), 33 electrical stimulation (ES) 34 and surgery 35 have also been used in the management of KD, but not all have shown efficacy in ethnic pigmented skin. These commonly available and newly emerging treatment modalities (Table 3) will be discussed in detail below.…”

“…69 It may be used in polytherapy to prevent recurrence of KD after surgical excision. 32 One study compared topical imiquimod with steroid injection following earlobe keloid excision in four patients. 70 Two patients had recurrences, but the small, uncontrolled nature of the study means that it is difficult to draw direct comparisons.…”

V-Y Advancement Flap: Aesthetic Reconstruction for Auriculotemporal Keloid Excision

“…Studies have found that keloid treatment is most effective when using multiple modalities, but there is still much controversy as to what is the optimal treatment [7]. Surgical excision without adjuvant therapy of the keloids, irrespective of the location, is said to have a recurrence rate between 45% and 100% [9].…”

Treatment of Earlobe Keloids by Extralesional Excision Combined with Preoperative and Postoperative “Sandwich” Radiotherapy

“…10 Radiotherapy has been hypothesized to destroy fibroblasts, connective tissue stem cells, and acute inflammatory cells. 16 Side effects include hyperpigmentation, pruritus, and erythema. Radiotherapy, as a single-treatment modality, was found to have variable response rates of 10 to 94 percent.…”

“…16 In a large review study, the crude risk for developing radiation-induced malignancy following radiotherapy administered for keloid treatment was found to be one in 1348. 24 The risk may be underestimated, however, as patients were not followed up for decades.…”