What Do We Know About Treating Recalcitrant Auricular Keloids? A Systematic Review and Meta-Analysis

Abstract

Background: Recalcitrant auricular keloids are keloids that have recurred after any previous treatment. They have been shown to have an increased likelihood of recurrence. There is no consensus on how best to treat recalcitrant auricular keloids. Here, we perform the first systematic review and meta-analysis investigating the evidence for treating recalcitrant auricular keloids. Methods: We searched MEDLINE, EMBASE, CINAHL, and EBM Reviews using specific keywords. Prespecified inclusion and exclusion criteria were used to assess article eligibility. Data were extracted for number of recalcitrant keloids, treatment modality, recurrence, and minimum follow-up time. Included articles were stratified by treatment and assigned a level of evidence (LOE) based on the Oxford Centre for Evidence-Based Medicine guidelines. A meta-analysis was performed to estimate recurrence rates with 95% confidence intervals for each treatment modality. Results: A total of 887 unique articles were identified and 13 included. Eleven were LOE III and 2 were LOE IV. Recurrence rates were found to be 9% (95% CI: 3%-25%) for excision with adjuvant brachytherapy, 14% (95% CI: 12%-17%) for excision with adjuvant compression therapy, 17% (95% CI: 3%-56%) for excision with adjuvant external beam radiation, and 18% (95% CI: 4%-53%) for excision with adjuvant steroid injections. No statistical significant difference was found. Conclusions: Data for treatment of auricular keloids are heterogeneous with few high-quality studies. Excision with adjuvant brachytherapy has the lowest recurrence rate in our analysis. Narrow confidence intervals reported here for brachytherapy and compression therapy may help surgeons more confidently recommend either of these treatment modalities to patients.

Post-operative KEloids iRradiation (POKER): does the surgery/high-dose interventional radiotherapy association make a winning hand?

“…A systematic review and meta-analysis conducted by Zawadiuk et al (2022) included 795 auricular keloids, revealing a recurrence rate of 9% after POIRT, 14% after excision with adjuvant compression therapy, 17% after excision with PORT EBRT, and 18% after excision with adjuvant steroid injections. The difference in recurrence rates among the four treatment groups was not statistically significant [ 22 ].…”

Compression Therapy for Keloid Scars: A Systematic Review and Meta-analysis

“…Zawadiuk and colleagues conducted a systematic review and meta-analysis studying recalcitrant auricular keloids specifically. 44 They collated data from studies that used four treatment modalities: surgical excision with brachytherapy, surgical excision with compression therapy, surgical excision with external beam radiation, and surgical excision with steroid injections. 44 Recurrence rates were 9% (95% CI, 3%–25%), 14% (95% CI, 12%–17%), 17% (95% CI, 3%–56%), and 18% (95% CI, 4%–53%) respectively.…”

Triple Therapy Protocol for Primary and Secondary Auricular Keloids: A Prospective Outcome Evaluation

“…A recent systematic review on recalcitrant auricular keloids reported recurrence rates as high as 17% after excision and pressure therapy, 25% after excision and brachytherapy, 53% after excision and steroid injections, and 56% after excision and external beam radiation. 11 The primary aim of this study was to test the effectiveness of the triple therapy protocol for secondary auricular keloids, to avoid radiation therapy as a last resort. As described, triple therapy involves intramarginal resection under magnification, tensionless wound closure with a limited number of thin monofilament sutures, a sequence of steroid injections, and local pressure therapy with a custom-made acrylate device.…”

“…A recent systematic review on recalcitrant auricular keloids reported recurrence rates as high as 17% after excision and pressure therapy, 25% after excision and brachytherapy, 53% after excision and steroid injections, and 56% after excision and external beam radiation. 11 …”