Efficacy of Triple Therapy in Auricular Keloids

BACKGROUND: Keloids are characterised by their continued growth following trauma, extension into normal tissue and their high recurrence rate following excision. Auricular keloids are common following ear piercing or flame burns. These lesions are highly conspicuous and cosmetically unappealing. Multiple methods including surgery, radiotherapy, antimitotic agents, silicone sheet, pressure clips and cryotherapy have been advocated. The risk of recurrence and the need to prevent distortion of the three-dimensional structure of the ear following resection is a challenge to the cutaneous surgeon. OBJECTIVES: To devise a standard protocol for management of auricular keloids with minimal distortion and recurrence. SETTING AND DESIGN: The patients underwent day-care surgery and subsequent out-patient follow-up for a minimum period of 1 year. METHODS: Ten patients presenting with 22 ear keloids were enrolled into a keloid protocol: (a) surgical excision and keloid rind flap cover with (b) intra-operative and post-operative intra-lesional steroid and (c) silicone sheet application. Subjective assessment on follow-up was using Patient Observer Scar Assessment Scale and objective assessment was by Beausang scale. STATISTICAL ANALYSIS USED: Microsoft Excel and Statistical Package for the Social Sciences (SPSS). Kaplan-Meier survival analysis curve used to calculate Recurrence Free period. RESULTS: Two out of 22 (9.1%) keloids developed post-excision recurrence after a mean follow -up period of 16 months. The average keloid recurrence free interval was 21 months. CONCLUSION: Triple combination therapy for keloids on the ear is a simple technique for management with preservation of contour of the ear and a low recurrence rate.