There is no therapeutic guide that indicates a specific management direction, and there are many methods available to treat them. Most authors propose the combination of different therapeutic tools, although, in the area of the ear (unlike the rest of the body), the surgical approach (extirpation) is usually one of the protagonists. Below we discuss the different therapeutic options that are proposed:
- Gel or silicone patch. The application of silicone products that exert some pressure on the scar is the initial preventive treatment due to its simplicity. This does not mean that it is no longer effective, since efficiencies of 70-80% have been reported to prevent the recurrence of hypertrophic and keloid scars.
- Intralesional injection of corticosteroids. Corticosteroids improve keloids through different anti-inflammatory mechanisms, such as reducing glycosaminoglycan synthesis, fibroblast activity, and collagen formation. If the keloid ear is not very large, they can be used as the first therapeutic option due to their simplicity of administration and speed of action, with favorable responses in 50-100% of cases. Although they are a simple and safe option, they are related to some adverse effects such as pain at the time of injection, hypo / hyperpigmentation, the appearance of telangiectasias (capillaries) or atrophy at the injection site in up to 63% of patients. cases.
Ear Keloid Treatment & Prevention
The intralesional injection of corticosteroids is a classic and effective treatment for the treatment of keloids. It can be used preventively or already when the keloid is formed.
- Intralesional injection of 5FU. 5-Fluorouracil inhibits the proliferation of fibroblasts, the cells responsible for synthesizing collagen. Some authors have reported flattening of the keloids of 88% treated only with this drug. You can learn more about the 5FU here.
- Cryotherapy. Liquid nitrogen induces by freezing a closure of the vessels that nourish the keloid and, secondarily, a reduction in its size. It is an extraordinarily simple and minimally painful treatment , which is why it constitutes one of the main pillars in keloid therapy. It can be combined with other techniques, such as intralesional injection or lasers. One session can be done every 3-4 weeks. It is possible that after cryotherapy, blisters or fine scabs may form on the surface of the keloid. Some studies show keloid flattening results of up to 73%.
Cryotherapy is a very simple and not very painful technique, which is why it is usually used in the first therapeutic stages of keloids and hypertrophic scars.
- Surgical excision. Removal of the keloid using a scalpel and suturing the skin is usually relatively straightforward, although it is associated with a 50-100% recurrence rate . For this reason, it is exceptional that it is used as the only therapeutic option without combining it with others (radiotherapy, intralesional injection of corticosteroids, occlusive silicone dressings, immunotherapy). There are retrospective studies in which it is observed that the combination of surgery plus infiltration with corticosteroids and occlusive dressings, or surgery plus radiotherapy and intralesions corticosteroids together are superior optionsto surgery and only infiltration with corticosteroids.
There are studies that combine the excision of the keloid center (“ keloid core excision ”) or its shaving with subsequent application of intralesional corticosteroids, imiquimod 5%, cryotherapy or silicone patches with excellent results. Using the “ core excision ” technique, only the center of the keloid is removed to drastically reduce its volume and the edges are sutured directly, ensuring that there is no tension in the scar itself.
- Lasers. Several types of lasers have shown efficacy in the treatment of ear keloids, such as CO2, argon, Nd: YAG (more information here ) and even pulsed light. Excision of the keloid with a CO2 laser is an alternative to classical surgery and has the advantage that intraoperative bleeding is less – the laser cuts and coagulates simultaneously – and the execution of the procedure is faster than with a scalpel and suture. It seems that an excellent combination of treatments in terms of results is the excision of the keloid, plus preventive intralesional application of corticosteroids and post-surgical use of silicone patches ( triple therapy ).
- Radiation therapy. It is rarely used as a sole treatment. It is generally used after surgical excision of the keloid. In these cases, some studies confirm recurrences in less than 10% of cases. Although radiotherapy is generally associated with notable adverse effects, when it is used at an adequate dose and with protection of the surrounding organs, the risk of carcinogenesis is very low.
Ear keloid treatment
The result after a session of Co2 laser plus cryotherapy and intralesional corticosteroid infiltration.
- Unlike other areas of the body, ear keloids can be treated by excision , with subsequent application of some additional technique (radiotherapy, intralesional injection of corticosteroids and / or silicone patches).
- Surgical or CO2 laser excision is not recommended as isolated techniques , since the recurrence rate is very high. It is necessary to combine them with other therapeutic options.
- Cryotherapy and intralesional injection of corticosteroids and / or 5-fluorouracil are simple techniques that can be used to reduce the size of ear keloids.