Tuesday, December 30, 2014

How to Get Rid of Keloid on Ear Piercing

Keloid formation has been hypothesized to be the result of an abnormal or prolonged wound healing process, with persistent proliferation and extracellular matrix production of fibroblasts that should otherwise discontinue in normal wound healing.

Despite the high prevalence of keloids in the general population, they are still known to be one of the more challenging dermatologic conditions to manage.  They are considered more than a cosmetic nuisance, and can present a significant psychosocial burden for the individuals who have unfortunately ended up with one or more of those scars.

Keloids occur most commonly on the chest, shoulders, upper back, back of the neck and earlobes.  Based on statistics, for unknown reasons, keloids appear to occur more frequently among Blacks, Hispanics and Asians, and less commonly in Caucasians.

While keloids that develop on some areas of the body of a woman for example, can be masked with clothing, those appearing on the back of the neck and especially on the earlobes, are very difficult to conceal. As a result, many women have to go around daily with these noticeable, and sometimes very ugly scars. Not only can this mar the physical beauty of  these women, it can also affects them psychologically, in particular their self-images, and have a negative impact on their overall quality of life.

Presently, in treating keloids in general, although multiple treatment modalities exist, no single treatment has proven widely effective. In fact, recurrence following any form of single treatment is generally the norm. Thus, combination therapy is likely the optimal strategy.

Keloids Management
Intra-lesional corticosteroid injections --- which help soften and reduce symptoms of pruritus and tenderness--- are believed to be by far the most common treatment option available at present, simply because they reduce inflammation and prevent the formation of abnormal collagen. With this approach, Triamcinolone acetonide, the most commonly used steroid, is injected directly into the keloid. However, because results are temporary; follow-up treatments are usually required. Multiple injections at regular monthly intervals are generally required for larger keloids.

The complications of intralesional steroid use include, skin atrophy, hypo-or hyperpigmentation, and the development of telangiectasias. Because patients typically require multiple needle sticks, especially for larger lesions, some authors suggest pre-treatment with topical lidocaine or the addition of lidocaine in the syringe to help get rid of injection-associated pain. Another negative finding is that Intralesional steroid injection may be impractical for very large or multiple keloids, since the pain of injection may be considerable. There is also additional concern, due to large doses of corticosteroids.

Surgical Excision

Some experts believe surgical excision may be gratifying, providing an immediate cosmetic correction, but the problem here  however, is that surgical resection of keloids is contraindicated, due to the high rate of occurrence (meaning that the keloids reappear after surgery). In fact, the excision often leads to a longer scar and the potential for a larger keloid in event of recurrence. As a result, it’s rarely used alone. Surgery is often combined with other treatment modalities.

This involves applying extremely low-temperature cryogens, such as liquid nitrogen, to the skin. It’s believed to work by altering collagen synthesis and promoting normal wound healing. This method allegedly works best on smaller keloids, but is limited by considerable pain and sometimes prolonged healing after treatment. Because several treatments are often needed, the risk for hypopigmentation in darker-skinned patients is also a significant drawback.

Radiotherapy is frequently used in combination with surgery. However, its use is controversial, due to reports that it is linked to the development of cancer.  Nonetheless, most experts argue that the associated risk is extremely low. Due to the uncertainty of the risk, some author recommend limiting its use to those who have failed previous excisional treatments, and to patients, age 21 or older.

Silicone Gel Sheeting
Based on finding, this treatment course which can last up to 4 months, involves the application of flexible adhesive sheets to a wound to increase the temperature as well as water and oxygen concentrations in the wound --- factors that allegedly promote healing. These sheets that are applied directly to the affected area, are believed to be most successful when worn for 12 to 24 hours.

Laser treatment

Based on finding, the most promising laser treatment results allegedly come from the use of the 585nm pulsed dye laser (PDL). Use of the pulsed dye laser in combination with intralesional steroid injection may also help soften the lesions and enhance the integration of steroid, according to experts. Also, it has been said that the use of the laser as a monotherapy or in conjunction with intralesional triamcinolone injection has shown some promising results with a large percentage of patients remaining keloid-free at follow-up.

Other Treatments with Variable Success Rates
  • Bloodying
  • Retinoids
  • Calcium channel blockers
  • Mitomycin C and interferon-a 2b
  • Imiquimod - a topical cream that’s believed to stimulate the body’s immune system. It’s frequently used as an adjunct to prevent recurrence after a surgical removal of  keloid scars.

For now, it appears as if the greatest weapon against keloids is not only combination therapy, but also the closing of wounds with minimal tension, and patients education. Because patients with a previous keloid or a family history of keloids are at increased risk for developing abnormal scars, these individuals should be counseled against body piercing(such as ear piercing) and should avoid elective cosmetic procedures with a risk for scarring.

1.Dermatology Online Journal 13(30), Keloids:Pathiophysiology and management
2.Journal of Investigative Dermatology

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