|
|
LETTER TO EDITOR |
|
Year : 2014 | Volume
: 3
| Issue : 3 | Page : 210-211 |
|
Ear piercing: The sad story behind ear lobule Keloid
Vadisha Srinivas Bhat
Department of Otorhinolaryngology, K. S. Hegde Medical Academy, Mangalore, Karnataka, India
Date of Web Publication | 13-Aug-2014 |
Correspondence Address: Vadisha Srinivas Bhat Department of Otorhinolaryngology, K. S. Hegde Medical Academy, Mangalore - 575 018, Karnataka India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/2278-344X.138612
How to cite this article: Bhat VS. Ear piercing: The sad story behind ear lobule Keloid. Int J Health Allied Sci 2014;3:210-1 |
Sir,
Keloids are among the diseases which are easy to diagnose but difficult to treat. The term Keloid is derived from the Greek word for crab claw. [1] Keloid formation is a result of deviation of the normal healing process, which can be seen after surgical procedures, trauma, insect bites or even vigorous scratching.
Some common sites for Keloid formation are chest, shoulders, ear lobules, upper arms, and cheeks. [2] Keloids on ear lobules are common in younger females than males, because of the cosmetic piercing of the ear lobule. [3] Ear lobule Keloids account for 2.5% of cases which are usually secondary to ear piercing. [4] In India, it is even seen in males due to religious ear lobule piercing which is known as "Karna Vedha", which is performed in early infancy. However, considering the number of ear piercings performed, incidence of Keloid formation is very less. This may be explained by the inference of the study conducted by Lane et al. which showed that the chance of Keloid formation is less if ear piercing is performed before the age of 11 years. They also found that the occurrence of Keloid is more in patients with positive family history of Keloid. [5] Keloids are uncommon over 65 years of age. [3]
Diagnosis of ear lobule Keloid is easier than the rest of the body, where it has to be differentiated from hypertrophied scar, which even though inappropriately large, remains confined to the wound site. In contrast, the Keloid grows well beyond the margins of injury. [1] They appear as pink to brown colored rubbery, firm or fibrous nodule of variable size at the site of ear piercing [Figure 1]. The differential diagnosis of earlobe keloid include dermoid cyst, lipoma, fibroma, and adnexal tumors. However, the history and clinical examination is sufficient for the diagnosis in most of the cases. | Figure 1: Clinical photograph of Keloid of ear lobule following ear piercing
Click here to view |
There is no definite treatment protocol described for Keloids. Absence of a definitive treatment is due to incomplete understanding of the pathogenesis of Keloid formation. The irregular collagen architecture, and also the increased ratio of type I to type III collagen is the primary pathology in Keloids. [6]
Surgical excision of Keloids generally result in recurrence, with recurrence rates ranging from 40% to 100%. Silicone gel is used as an adjunct to Keloid excision and also as prophylaxis to prevent abnormal scarring following elective incisions in people with tendency or family history of Keloid formation. It can be used as topical gel or impregnated elastic sheet, which need to be used for at least 12 h a day. [1]
Medical therapies include intralesional injection of steroid triamcinolone acetonide which is an easy and affordable therapy with fairly good result [Figure 2]. Intralesional 5-flurouracil, interferon therapy and imiquimod therapy are the other options. Tacrolimus is a newer addition to the list. [3] Radiation therapy has been shown to effectively reduce the recurrence rate of Keloids. It works by directly damaging fibroblasts, which alters collagen structure and organization. [1] Laser therapy with argon laser, carbon dioxide laser, neodymium-doped yttrium aluminum garnet are attempted without much improved results. [3] | Figure 2: Clinical photograph of Keloid showing regression in response to intralesional triamcinolone
Click here to view |
Cryosurgery, intralesional antihistamines, colchicine, methotrexate, cyclosporine, D-penicillamine, and relaxin are among the other methods attempted. [1],[3] However, none of them show promising results.
To conclude, ear lobule Keloid is most unwanted happening after cosmetic ear piercing. As the treatment of this disease is yet to be standardized, prevention should be the option whenever possible. Patients with a family history of Keloids should avoid undergoing ear piercing. If at all piercing is mandatory, it should be performed in early childhood.
References | | |
1. | Davidson S, Aziz N, Rashid RM, Khachemoune A. A primary care perspective on keloids. Medscape J Med 2009;11:18. |
2. | Alster TS, Tanzi EL. Hypertrophic scars and keloids: Etiology and management. Am J Clin Dermatol 2003;4:235-43. |
3. | Kelly AP. Medical and surgical therapies for keloids. Dermatol Ther 2004;17:212-8. [PUBMED] |
4. | Park TH, Seo SW, Kim JK, Chang CH. Outcomes of surgical excision with pressure therapy using magnets and identification of risk factors for recurrent keloids. Plast Reconstr Surg 2011;128:431-9. [PUBMED] |
5. | Lane JE, Waller JL, Davis LS. Relationship between age of ear piercing and keloid formation. Pediatrics 2005;115:1312-4. |
6. | Friedman DW, Boyd CD, Mackenzie JW, Norton P, Olson RM, Deak SB. Regulation of collagen gene expression in keloids and hypertrophic scars. J Surg Res 1993;55:214-22. |
[Figure 1], [Figure 2]
|