Why do keloids people get Ear Keloids?

Keloids & hypertrophic scars are common in young people. They are due to excessive collagen production, resulting in a raised scar. Keloids by definition extend beyond the boundary of the scar, whilst hypertrophic scars lie within the scar line.

Trauma (such as ear piercings) can predispose patients to keloid scars. Other risk factors for keloids include –

• Gender. Females are more likely to get keloid scars.
• Ethnicity, more commonly seen in Asian and darker skin types.
• Age. Collagen production is accelerated in younger people compared to older patients.
• Inflammation and location; pressure areas such as the shoulders, back & chest areas are more prone to scarring.
• Thermal injury such as burns can elicit an exaggerated healing response.
• Surgical wounds

Keloids scars can respond to lasers & injections. For small scars on the ears, this may be a feasible option prior to the consideration of surgery. Treatment options include-

• Steroid injections. These are usually repeated at 6-8 weekly intervals.
• 5FU or chemotherapy injections. Repeated 6-8 weeks apart.
• Cryogen or cryoprobe, often in conjunction with steroid injections.
• Botox; this has been reported in the literature (low success rate).
• Silicone gel or sheeting, good as prevention (Stratamark)
• CO2 fractional laser; in combination with anti-inflammatory steroids
• Microneedling with steroid drip
• Vascular laser +/- anti-inflammatory injections
• Radiotherapy (fractionated, 4-10 sessions)
• Verapamil or Bleomycin injections

The ideal treatment will depend on the location of the scar, the size, your age & your past treatment (failures).

My preferred option is to surgically remove a keloid from the ear using a scalpel or a cutting CO2 laser. However, this creates a new wound that will likely develop a keloid as well. When treated with surgery alone, keloids usually come back, hence the use of pressure earrings & silicone tape/gel post-operatively.

Surgery involves an operation that takes 20-40 minutes to perform. I prefer to perform this under partial sedation (patient sedated, not me!). After excision (with minimal cautery), I then stitch the wound up (5-25 stitches). Removal of sutures should be done at 5-8 days after surgery, after which you will wear a pressure earring. The earrings are sourced in the United States, a few weeks prior to your surgery.

The combination of surgery & pressure earrings (worn for 3-6 months post-surgery) will cure 80-85% of ear keloids. If one fails this combination, a step-up treatment is re-excision coupled with fractional radiotherapy.

As soon as the wound heals, begin using silicone sheets or gel. Applying silicone sheets or gel can help prevent keloids from forming and reduce the size of existing scars. You can buy these products without a prescription. Early use of anti-inflammatory creams can help; refer below.