Keloids are scars that overgrow after tissue damage. The wound heals as a large, soft growth. Michael H. Tirgan, MD, attributes the keloid disorder to genetics. According to him, some people are more prone to develop them. In addition, an injury must be available to trigger the abnormal wound healing process.
However, the genetics, however, are not well understood or documented. Some people suffer from mild forms of the keloids while others suffer from a moderate to severe form of it.
For keloid scars to form, the normal healing process goes into overdrive. In normal situations, fresh skin develops or is laid down to heal damaged skin. The damaged area then fades away gradually. The keloid scar forms because the skin gets too much collagen laid down on it after the damage. This heals the wound ‘too much’. Instead of then fading away like it should normally do, the tissue stays there.
Keloid scars affect all races but are more prevalent with people of dark pigmentation. It mostly occurs during puberty or pregnancy when there is hyperactivity in the pituitary gland. They can take from three months to a year to form after the skin has been damaged. They start off as a skin lesion then grows over time. The longer they stay without being removed the larger it becomes. The rate of growth varies among individuals.
What triggers them – causes
The ears are one of the common locations for their development. Most of the time, ear keloid formation is triggered by piercing. The second type of injury is surgery done while removing a previous keloid or any other type of surgery including facelift surgery or otoplasty to reshape ears.
Ear keloids have a psycho-social impact on those affected. It causes aesthetic and functional problems since they are visible. It may also cause depression and anxiety issues if the ear becomes disfigured or the keloids keep recurring.
Removal or treating ear keloids
The treatment goal should be aimed at not only removing the keloid tissue successfully but also preventing ear damage and preventing recurrence. Various treatment methods are available with a variable success rate, Most doctors will combine the treatments for best results. The most common ear keloid removal treatments you should try include the following:
- Intralesional corticosteroid injections
- Laser therapy
- Silicone gel sheeting
Let us now look at each of these treatment or removal options in a little more details.
Surgery to remove primary keloids is somewhat contrary to the basic goals of the keloid removal. This is because it induces a new injury to the affected area. It may also result in loss of normal ear tissue surrounding it. This results in issues of aesthetics.
Some surgeons will downplay the loss of earlobe tissue or the disfigurement that will happen before they perform the surgery. As the patient, request a different option if you do not want this to happen.
This disfigurement or earlobe tissue loss could occur and still, the patient gets recurring cases. Surgery is therefore not a safe bet when trying to get rid of ear keloids. The extent of injury to the ear after surgery is more than what was there previously. This could then result in larger keloids. Secondary keloids tend to grow faster and if not treated can grow so big they deform the ear.
3. Intralesional corticosteroid injections
This is the injection of steroids and local anesthetic into the scar. The doctor uses tiny needles which could make the skin sore. These help in stopping the proliferation of fibroblasts or skin cells contained in the keloid scar. The corticosteroids also suppress the wound inflammation. The doctor will give one injection every month for four to six months.
The side effect of intralesional corticosteroids injection is that the skin gets easily damaged after since it becomes too thin.
If combined with surgery, the steroid therapy is done before surgery and done for at least 3 months.
3. Cryotherapy – lesser recurrence
Cryotherapy (cryosurgery) refers to the application of extreme cold to treat keloids. It’s the most effective, economical, easy to perform and safest method according to Dr. Tirgan. The recurrence rate after cryotherapy and successful removal depend on size, location, type, and genetics.
This method uses Liquid Nitrogen which can produce low temperatures. Nitrogen can be found in about 80% of the air we breathe. It’s inert, has no reactions and is not flammable. When placed under extreme pressure, nitrogen becomes a liquid. When it evaporates, it becomes really cold (-196 Celsius). The liquid nitrogen when applied to this tissue scar, freezes and destroys the keloid tissue.
When mountain climbers are exposed to extremely cold temperatures for long, they get frostbites that can lead to finger loss. The same principle is used to treat keloids. Direct application of liquid nitrogen, induces precise frostbite to the scar tissue. Cryotherapy flattens the keloid scars and very few recurrence cases happen with this method.
4. Laser therapy
A light with a specific wavelength from a laser devise is directed to the keloid. The trick is to find a laser device with the same wavelength laser beam as that of the keloid. Lasers can either be ablative or non-ablative depending on the effect they have on a tissue.
Ablative lasers remove all tissue or part of it by acting on water present in the tissue, causing them to vaporize.
Non-ablative lasers act on different structures including intracellular hemoglobin or melanin pigmentation. This then leads to the death of the structures without removing them.
It’s an effective method but make sure it’s done by a specialist qualified for the job.
5. Silicone gel sheeting
In this method, silicone gel or a silicone sheet is placed on the keloid. This helps reduce the scar thickness.
The silicone sheet is cumbersome and may be hard to keep on for long periods. The gel is easy to apply and invisible once dry. It takes some time to dry though and one has to wait it out before putting on any clothes.
Radiation therapy is done with high energy particles to destroy cancer cells. In cases of keloids, it’s done after surgery. This method is risky since it could result in cancer development.
7. Other modes of treatment include:
- Dressing up the keloid with steroid ointment to dampen down the scar. These tapes, impregnated with steroids, are prescribed by doctors for children who cannot tolerate steroid injections.
- Pressure therapy.
- Atlas of Ear Keloids By Michael H. Tirgan, MD