Keloid scars commonly occur on the ears and earlobes as a result of piercings. Although there is a tendency for keloids to recur, they can be successfully improved with steroid injections.
Keloids are benign tumors caused by an excessive proliferation of scar tissue. Normal scars flatten and soften over time, eventually fading to a near normal color, texture, and consistency matching the surrounding tissue. If a scar proliferates and thickens, it is called a hypertrophic scar. A keloid is distinguished from a hypertrophic scar because the keloid grows beyond the size of the original injury.
As with all scars, keloids are caused by injury to the skin. There is a strong genetic predisposition for forming keloids, particularly in people with African heritage. Keloids are commonly seen on the ears, where they may be stimulated by irritation from the earring or infection of the original piercing. It is extremely common to see multiple keloids on the same person. People with a history of keloids are advised to avoid further piercings and unnecessary body modifications.
Keloid scars are usually removed in the office under local anesthesia. A small flap of skin is raised around the edge of the keloid and then the abnormal scar tissue is surgically removed. The skin is artfully trimmed and folded to cover the defect and then repaired with fine sutures. The sutures are usually removed in less than a week to avoid creating a foreign body reaction to the suture material.
Steroids and pressure earrings may be used to reduce small keloids, or to prevent regrowth of keloids. For small keloids on the earlobe, clip-on earrings may be modified by gluing a dime to one or both sides of the clip creating a broad, flat surface area that applies direct pressure to the keloid. The physician often recommends injections of a long acting steroid such as triamcinolone directly into the scar at 6-12 week intervals. Over the course of a year or more, and the repair will often heal and further injections may be unnecessary. Should the keloid begin to grow again, it is most helpful to return to the physician and intervene early rather than to wait for the keloid to become large.