N. Drucker1, D. W. Kays1, S. D. Larson1, J. A. Taylor1, S. Islam1 1University Of Florida,Surgery,Gainesville, FL, USA
Introduction: Earlobe keloids are challenging conditions to manage in children due to high recurrence rates. There are a number of therapeutic alternatives available to treat these, which have not been reported in children. The purpose of this study is to investigate the management and outcomes of keloids in a large cohort and attempt to understand the optimal way of treating them.
Methods: We retrospectively analyzed all children who underwent surgical therapy for earlobe keloids over a 10-year period (2004-2014). Clinical data including etiology, demographics, treatment, and outcome were collected. A follow up phone survey was attempted on all patients to assess for long term recurrence and satisfaction. Data was analyzed using student’s t test and Fischer’s exact test as appropriate.
Results: A total of 95 patients with 135 keloids were identified. Mean age was 14.0 years, 54.3% were female, and a majority (85%) were African American (AA). The most common etiology was secondary to pierced earrings (88.4%). Mean keloid size was 2.4 cm (0.25-11 cm) and they were more common on the left earlobe (73.7% including bilateral). Excision with (n=56) or without (n=24) steroid was the most common surgical management, with some cases also having compression earrings, and others radiation therapy(n=8). Mean follow up of the entire cohort was 27 months. Recurrences were noted in 20 cases (21.1%), a majority of which were managed operatively (70%). The highest rate of recurrence was with those treated with radiation therapy (37.5%), while we found no difference in recurrence between excision alone vs. with steroid (20.8% vs. 19.6%). There have been 5 re recurrences as well. We found age less than 10 at surgery (p=0.015) to be a risk factor for recurrence, and all recurrences were in AA patients. Size of the lesion, gender, side, and nodular vs. pedunculated shape did not have any effect on recurrence. Phone follow up was achieved in 56% cases.
Conclusion: This is the largest series of earlobe keloid treatment reported in children. Younger age at excision and AA race are associated with increased risk of recurrent keloid. Intraoperative administration of steroids did not seem to influence recurrence rates, and radiation therapy was associated with a higher recurrence. Longer duration follow up is needed for establishing true recurrence rates, and a larger multi center study would help in answering these questions.