Management of Keloid Scars caused by Ear Piercings

Keloid scars can occur after ear piercings. They are typically large raised, firm nodules that occur at the site of the piercing. They can become painful and physically disfiguring.

The cause is thought to be epithelial (skin) entrapment along the piercing tract. This can occur if the piercing gets inflamed or is allowed to seal. Trapped skin proliferates uncontrollably and causes inflammatory scar reaction. Cartilage piercing is particularly sensitive to this complication. 

Initial treatment involves injection of steroids into the keloid. If that does not help, injection with a chemotherapy drug such as 5-fluorouracil (5-FU) is done. If that does not work, then surgical removal of the keloid is needed. Re-piercing of the ear can be performed approximately one month after surgery. After re-piercing the ear, it is important to keep the area clean, by cleaning with hydrogen peroxide. Frequent twisting of the earring also keeps the hole open. Most patients do very well after removal and re-piercing of the ear. Rarely, recurrence of the keloid scar may occur. With close follow-up keloids can be prevented with steroid injections.

Patient presented with multiple caused by piercings (left). Initial treatment with injection of steroids (center). Ear is seen after surgical removal (right).

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