Advertisement

European Archives of Oto-Rhino-Laryngology

, Volume 264, Issue 12, pp 1497–1508 | Cite as

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

  • K. FroelichEmail author
  • R. Staudenmaier
  • N. Kleinsasser
  • R. Hagen
Miscellaneous

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.

Keywords

Auricular keloids Keloid therapy Surgery of auricular keloids 

References

  1. 1.
    Aköz T, Gideroglu K, Akan M (2002) Combination of different techniques for the treatment of earlobe keloids. Aesthetic Plast Surg 26:184–188PubMedCrossRefGoogle Scholar
  2. 2.
    Al-Attar A, Mess S, Thomassen JM, Kauffman CL, Davison SP (2006) Keloid pathogenesis and treatment. Plast Reconstr Surg 117:286–300PubMedCrossRefGoogle Scholar
  3. 3.
    Apikian M, Goodman G (2004) Intralesional 5-fluorouracil in the treatment of keloid scars. Australas J Dermatol 45:140–143PubMedCrossRefGoogle Scholar
  4. 4.
    Berman B, Flores F (1997) Recurrence rates of excised keloids treated with postoperative triamcinolone acetonide injections or interferon alfa-2b injections. J Am Acad Dermatol 37:755–757PubMedCrossRefGoogle Scholar
  5. 5.
    Berman B, Kaufman J (2002) Pilot study of the effect of postoperative imiquimod 5% cream on the recurrence rate of excised keloids. J Am Acad Dermatol 47:S209–S211PubMedCrossRefGoogle Scholar
  6. 6.
    Borok TL, Bray M, Sinclair I, Plafker J, Labirth L, Rollins C (1988) Role of ionizing irradiation for 393 keloids. Int J Radiat Oncol Biol Phys 15:865–870PubMedGoogle Scholar
  7. 7.
    Botwood N, Lewanski C, Lowdell C (1999) The risks of treating keloids with radiotherapy. Br J Radiol 72:1222–1224PubMedGoogle Scholar
  8. 8.
    Brent B (1978) The role of pressure therapy in management of earlobe keloids. Ann Plast Surg 1:579–581PubMedCrossRefGoogle Scholar
  9. 9.
    Brown LA, Pierce HE (1986) Keloids: scar revision. J Dermatol Surg Oncol 12:51–56PubMedGoogle Scholar
  10. 10.
    Buchwald C, Nielsen LH, Rosborg J (1992) Keloids of the external ear. ORL J Otorhinolaryngol Relat Spec 54:108–112PubMedGoogle Scholar
  11. 11.
    Chaudhry MR, Akhtar S, Duvalsaint F, Garner L, Lucente FE (1994) Ear lobe keloids, surgical excision followed by radiation therapy: a 10-year experience. Ear Nose Throat J 73:779–781PubMedGoogle Scholar
  12. 12.
    Chen T, Kunnavatana SS, Koch RJ (2006) Effects of mitomycin-C on normal dermal fibroblasts. Laryngoscope 116:514–517PubMedCrossRefGoogle Scholar
  13. 13.
    Chowdri NA, Masarat M, Mattoo A, Darzi MA (1999) Keloids and hypertrophic scars: results with intraoperative and serial postoperative corticosteroid injection therapy. Aust N Z J Surg 69:655–659PubMedCrossRefGoogle Scholar
  14. 14.
    Cohen IK, Diegelmann RF, Johnson ML (1977) Effect of corticosteroids on collagen synthesis. Surgery 82:15–20PubMedGoogle Scholar
  15. 15.
    Copcu E, Sivrioglu N, Oztan Y (2004) Combination of surgery and intralesional verapamil injection in the treatment of the keloid. J Burn Care Rehabil 25:1–7PubMedCrossRefGoogle Scholar
  16. 16.
    D’Andrea F, Brongo S, Ferraro G, Baroni A (2002) Prevention and treatment of keloids with intralesional verapamil. Dermatology 204:60–62PubMedCrossRefGoogle Scholar
  17. 17.
    Davison SP, Mess S, Kauffman LC, Al-Attar A (2006) Ineffective treatment of keloids with interferon alpha-2b. Plast Reconstr Surg 117:247–252PubMedCrossRefGoogle Scholar
  18. 18.
    de Oliveira GV, Nunes TA, Magna LA, Cintra ML, Kitten GT, Zarpellon S, Raposo Do Amaral CM (2001) Silicone versus nonsilicone gel dressings: a controlled trial. Dermatol Surg 27:721–726PubMedCrossRefGoogle Scholar
  19. 19.
    Dinh Q, Veness M, Richards S (2004) Role of adjuvant radiotherapy in recurrent earlobe keloids. Australas J Dermatol 45:162–166PubMedCrossRefGoogle Scholar
  20. 20.
    Ehrlich HP, Desmouliere A, Diegelmann RF, Cohen IK, Compton CC, Garner WL, Kapanci Y, Gabbiani G (1994) Morphological and immunochemical differences between keloid and hypertrophic scar. Am J Pathol 145:105–113PubMedGoogle Scholar
  21. 21.
    Eishi K, Bae SJ, Ogawa F, Hamasaki Y, Shimizu K, Katayama I (2003) Silicone gel sheets relieve pain and pruritus with clinical improvement of keloid: possible target of mast cells. J Dermatolog Treat 14:248–252PubMedCrossRefGoogle Scholar
  22. 22.
    Englisch RS, Shenefelt PD (1999) Keloids and hypertrophic scars. Dermatol Surg 25:631–638CrossRefGoogle Scholar
  23. 23.
    Fikrle T, Pizinger K (2005) Cryosurgery in the treatment of earlobe keloids: report of seven cases. Dermatol Surg 31:1728–1731PubMedCrossRefGoogle Scholar
  24. 24.
    Fitzpatrick RE (1999) Treatment of inflamed hypertrophic scars using intralesional 5-FU. Dermatol Surg 25:224–232PubMedCrossRefGoogle Scholar
  25. 25.
    Fulton JE (1995) Silicone gel sheeting for the prevention and management of evolving hypertrophic and keloid scars. Dermatol Surg 21:947–951PubMedCrossRefGoogle Scholar
  26. 26.
    Funayama E, Chodon T, Oyama A, Sugihara T (2003) Keratinocytes promote proliferation and inhibit apoptosis of the underlying fibroblasts: an important role in the pathogenesis of keloid. J Invest Dermatol 121:1326–1331PubMedCrossRefGoogle Scholar
  27. 27.
    Giugliano G, Pasquali D, Notaro A, Brongo S, Nicoletti G, D’Andrea F, Bellastella A, Sinisi AA (2003) Verapamil inhibits interleukin-6 and vascular endothelial growth factor production in primary cultures of keloid fibroblasts. Br J Plast Surg 56:804–809PubMedCrossRefGoogle Scholar
  28. 28.
    Granstein RD, Rook A, Flotte TJ, Haas A (1990) A controlled trial of intralesional recombinant interferon-γ in the treatment of keloidal scarring. Arch Dermatol 126:1295–1301PubMedCrossRefGoogle Scholar
  29. 29.
    Grimes PE, Hunt SG (1993) Considerations for cosmetic surgery in the black population. Clin Plast Surg 20:27–34PubMedGoogle Scholar
  30. 30.
    Gupta S, Kalra A (2002) Effiacy and safety of intralesional 5-flourouracil in the treatment of keloids. Dermatology 204:130–132PubMedCrossRefGoogle Scholar
  31. 31.
    Hackert I, Aschoff R, Sebastian G (2003) Keloide und ihre Therapie. Hautarzt 54:1003–1015PubMedCrossRefGoogle Scholar
  32. 32.
    Hatoko M, Kuwahara M, Shiba A, Tada H, Okazaki T, Muramatsu T, Shirai T (1998) Earlobe reconstruction using a subcutaneous island pedicle flap after resection of “earlobe keloid”. Dermatol Surg 24:257–261PubMedCrossRefGoogle Scholar
  33. 33.
    Jemec B, Linge C, Grobbelaar AO, Smith PJ, Sanders R, McGrouther DA (2000) The effect of 5-fluorouracil on Dupuytren fibroblast proliferation and differentiation. Chir Main 19:15–22PubMedCrossRefGoogle Scholar
  34. 34.
    Kelly AP (2004) Medical and surgical therapies for keloids. Dermatol Ther 17:212–218PubMedCrossRefGoogle Scholar
  35. 35.
    Kim JY, Stewart CE (2004) Application of Mitomycin-C for head and neck keloids. Otolaryngol Head Neck Surg 131(2):P73CrossRefGoogle Scholar
  36. 36.
    Kim DY, Kim ES, Eo SR, Kim KS, Lee SY, Cho BH (2004) A surgical approach for earlobe keloid: keloid fillet flap. Plast Reconstr Surg 113:1668–1674PubMedCrossRefGoogle Scholar
  37. 37.
    Lawrence WT (1996) Treatment of earlobe keloids with surgery plus adjuvant intralesional verapamil and pressure earrings. Ann Plast Surg 37:167–169PubMedCrossRefGoogle Scholar
  38. 38.
    Lee RC, Ping JA (1990) Calcium antagonists retard extracellular matrix production in connective tissue equivalent. J Surg Res 49:463–466PubMedCrossRefGoogle Scholar
  39. 39.
    Lee J, Yang CC, Chao SC, Wong TW (2004) Histopathological differential diagnosis of keloid and hypertrophic scar. Am J Dermatopathol 26:379–384PubMedCrossRefGoogle Scholar
  40. 40.
    Mall JW, Pollmann C, Müller JM, Buttemeyer R (2002) Keloidbildung des Ohrläppchens nach Ohrlochstechen. Chirurg 73:514–516PubMedCrossRefGoogle Scholar
  41. 41.
    Martin-García RF, Busquets AC (2005) Postsurgical use of imiquimod 5% cream in the prevention of earlobe keloid recurrences: results of an open-label, pilot study. Dermatol Surg 31:1394–1398PubMedCrossRefGoogle Scholar
  42. 42.
    Mizuno H, Cagri Uysal A, Koike S, Hyakusoku H (2006) Squamous cell carcinoma of the auricle arising from keloid after radium needle therapy. J Craniofac Surg 17:360–362PubMedCrossRefGoogle Scholar
  43. 43.
    Mustoe TA, Cooter RD, Gold MH, Hobbs FD, Ramelet AA, Shakespeare PG, Stella M, Teot L, Wood FM, Ziegler UE (2002) International clinical recommendations on scar management. Plast Reconstr Surg 110:560–571PubMedCrossRefGoogle Scholar
  44. 44.
    Nanda S, Reddy BS (2004) Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatol Surg 30:54–57PubMedCrossRefGoogle Scholar
  45. 45.
    Nason KH (1942) Keloids and their treatment. N Engl J Med 226:883–886CrossRefGoogle Scholar
  46. 46.
    Ragoowansi R, Cornes PG, Glees JP, Powell BW, Moss AL (2001) Ear-lobe keloids: treatment by a protocol of surgical excision and immediate postoperative adjuvant radiotherapy. Br J Plast Surg 54:504–508PubMedCrossRefGoogle Scholar
  47. 47.
    Ragoowansi R, Cornes PG, Moss AL, Glees JP (2003) Treatment of keloids by surgical excision and immediate postoperative single-fraction radiotherapy. Plast Reconstr Surg 111:1853–1859PubMedCrossRefGoogle Scholar
  48. 48.
    Rusciani L, Paradisi A, Alfano C, Chiummariello S, Rusciani A (2006) Cryotherapy in the treatment of keloids. J Drugs Dermatol 5:591–595PubMedGoogle Scholar
  49. 49.
    Saha SS, Kumar V, Khazanchi RK, Aggarwal A, Garg S (2004) Primary skin grafting in ear lobule keloid. Plast Reconstr Surg 114:1204–1207PubMedCrossRefGoogle Scholar
  50. 50.
    Sanders KW, Gage-White L, Stucker FJ (2005) Topical mitomycin C in the prevention of keloid scar recurrence. Arch Facial Plast Surg 7:172–175PubMedCrossRefGoogle Scholar
  51. 51.
    Saray Y, Gulec AT (2005) Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study. Int J Dermatol 44:777–784PubMedCrossRefGoogle Scholar
  52. 52.
    Sclafani AP, Gordon L, Chadha M, Romo T III (1996) Prevention of earlobe keloid recurrence with postoperative corticosteroid injections versus radiation therapy: a randomized, prospective study and review of the literature. Dermatol Surg 22:569–574PubMedCrossRefGoogle Scholar
  53. 53.
    Shons AR, Press BH (1983) The treatment of earlobe keloids by surgical excision and postoperative triamcinolone injection. Ann Plast Surg 10:480–482PubMedCrossRefGoogle Scholar
  54. 54.
    Simman R, Alani H, Williams F (2003) Effect of mitomycin C on keloid fibroblasts: an in vitro study. Ann Plast Surg 50:71–76PubMedCrossRefGoogle Scholar
  55. 55.
    Stashower ME (2006) Successful treatment of earlobe keloids with imiquimod after tangential shave excision. Dermatol Surg 32:380–386PubMedCrossRefGoogle Scholar
  56. 56.
    Stewart CE IV, Kim JY (2006) Application of mitomycin-C for head and neck keloids. Otolaryngol Head Neck Surg 135:946–950PubMedCrossRefGoogle Scholar
  57. 57.
    Talmi YP, Orenstein A, Wolf M, Kronenberg J (2005) Use of mitomycin C for treatment of keloid: a preliminary report. Otolaryngol Head Neck Surg 132:598–601PubMedCrossRefGoogle Scholar
  58. 58.
    Worret WI, Vogt HJ (2004) Narbentherapie in der Dermatologie. Dtsch Arztebl 101:2819–2824Google Scholar
  59. 59.
    Wu WS, Wang FS, Yang KD, Huang CC, Kuo YR (2006) Dexamethasone induction of keloid regression through effective suppression of VEGF expression and keloid fibroblast proliferation. J Invest Dermatol 126:1264–1271PubMedCrossRefGoogle Scholar
  60. 60.
    Xia W, Phan TT, Lim IJ, Longaker MT, Yang GP (2004) Complex epithelial–mesenchymal interactions modulate transforming growth factor-beta expression in keloid-derived cells. Wound Repair Regen 12:546–556PubMedCrossRefGoogle Scholar
  61. 61.
    Xia W, Phan TT, Lim IJ, Longaker MT, Yang GP (2006) Differential transcriptional responses of keloid and normal keratinocytes to serum stimulation. J Surg Res 135:156–163PubMedCrossRefGoogle Scholar
  62. 62.
    Ziccardi VB, Lamphier J (2000) Use of keloid skin as an autograft for earlobe reconstruction after excision. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89:674PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • K. Froelich
    • 1
    Email author
  • R. Staudenmaier
    • 2
  • N. Kleinsasser
    • 1
  • R. Hagen
    • 1
  1. 1.Department of Otolaryngology, Head and Neck SurgeryUniversity of WuerzburgWürzburgGermany
  2. 2.Department of Otolaryngology, Head and Neck SurgeryTechnical University MunichMunichGermany

Personalised recommendations