The use of triamcinolone combined with surgery in major ear keloid treatment: a personal two stages approach

Background: Keloid is a fibroproliferative disorder characterized by an abnormal deposition of collagen within a wound. Despite an increased understanding of wound healing and collagen metabolism, the exact cause, the clinical behavior, and gold standard of treatment for keloids remain an enigma. There is no one right way of treatment, the results are variable, and the management of ear keloids can be difficult and frustrating both for patients and physicians. Traditional techniques include intralesional steroids, topical applications of silicone, vitamins, and segmental excision by lasers or surgery. The purposes of this article are to review the literature concerning the current therapies as well as to present the authors’ experience in the treatment of major ear keloids. Methods: Twenty-seven consecutive black race patients (18 cases and 9 controls) underwent surgery for major keloids of the external ear at the Plastic and Reconstructive Surgery Unit of University of Palermo. The authors performed the radical excision and intralesional triamcinolone acetonide injection intraoperative and 1 month after surgical treatment. Results: No complications were noticed in the early postoperative period, and no recurrence was noticed in all the patients. Conclusions: The radical excision and the intralesional triamcinolone acetonide injection appear to be a successful option of treatment for major ear keloids. Compared to other methods, it does not necessitate several stages of treatment, moreover, it has the advantages to lower the risk of recurrence, the healing process is rapid, and improvement of quality of life is significant. Level of evidence: Level IV, therapeutic study