Earlobe Keloid

The ears are common locations for the development of keloids. The injury that triggers ear keloid formation is almost always due to piercing.

The second most common type of injury to the ear is surgery, either to remove a previously formed keloid, or surgery for other reasons, such as otoplasty to reshape the ears, or facelift surgery.

The worsening of earlobe keloids after surgical excision is most definitely due to triggering the underlying dysregulated wound healing mechanisms. This is in response to a new, yet greater, dermal injury, i.e. surgery, which is more extensive in nature than the original piercing injury.

The age of onset for the development of keloid peaks during puberty and the early teens. It is therefore postulated that, although the genetic susceptibility is transmitted from parents to their children, the actual disorder is not triggered until children reach puberty.

The most captivating case I have encountered was a young African American female who had keloids in both her ears. Her earlobes were pierced when she was very little. It was only when she was between fifteen and sixteen years of age when she first noticed keloids forming on her earlobes at the sites of her old piercings.

Cryosurgery, which is a method of inducing controlled frostbit, is the very best method of treating ear/earlobe keloids. The videos in this page and on my youtube channel depict how I utilize cryotherapy for treatment of ear/earlobe keloids. Most earlobe/ear keloids require about 3-4 rounds of cryotherapy, delivered every 6-8 weeks. Most patients will achieve excellent results with this course of treatment.

To learn more about ear/earlobe keloids, please refer to Dr. Tirgan’s new book, Atlas of Ear Keloids. This book is a must read book for anyone with ear keloid, specially those who have not had surgery yet. Make sure you read this book before choosing surgery for your keloid. This book is available on Amazon.com. To order the book, you can click on the book image below.

Posterior Auricular Keloids

Keloids can occur is almost every part of skin, including behind the ears. These keloid often develop subsequent to a corrective surgery to re-shape the ears.
Treating posterior auricular keloids pose a challenge to the patient, as well as the treating physician. The biggest fault in treating these keloids is that the plastic surgeons often proceed with surgical removal of these keloids which almost always results in recurrence of the keloid, yet in a more severe form. We need to keep in mind the fact that it was the very first surgery that resulted in formation of the keloid.

Cryotherapy is by far the best treatment for all posterior auricular keloids. Patients should avoid repeat surgery. Radiation therapy should never be used in treatment of the keloids. Video below depicts the treatment results that Dr. Tirgan has achieved with cryotherapy.

Facial Keloids

Keloids that form on person’s face are always visible, cannot be hidden, and cause tremendous stress and anxiety for the individual. This condition is most common among Africans, African Americans and men with thick and curly facial hair. Cause of this type of keloid is unknown; however the triggering factors for this type keloid are most often acne and ingrown facial hair. Skin injury from razor blades in those who are genetically prone, can results in formation of these keloids.
Those who notice early stages of this condition must avoid usage of razor blades on their face and must take an aggressive approach to treatment of their acne.

As depicted below, the size and extent of this kind of keloids varies, from small keloids, to huge and massive keloids.
Treatments of facial keloids have to be planned very carefully. General principles of keloid treatment apply to facial keloids as well. With very high rate of recurrence and risk of worsening of keloids after surgery, I favor medical treatment for these keloids and avoid surgery and radiation therapy all together.

Keloids in the Neck

Keloids can occur is almost every part of skin, including in the neck, either in the front or back. Keloids of the neck pose their own specific problems. Neck keloids are often bulky and visible; and impossible to hide, causing stress and anxiety.

Treatment has to be planned very carefully. General principles of keloid treatment apply to these keloids as well. Surgery quite often results in worsening of these keloids, leading at times to loss of function and mobility of the neck. Radiation therapy should be avoided, as it for sure will cause hypothyroidism, a new disease that the patients have to deal with for the rest of their lives. Radiation can also cause cancer of thyroid and damage to major blood vessels of the neck which may result in premature strokes and host of other long term complications.

Patient depicted in below photograph has totally lost the function of his neck and has been suffering from chronic abscesses, deep in his neck, for many years now
Image below depicts a young woman who had aggressive surgery and radiation therapy to her neck. Not only the treatment did not resolve the keloid issue, it also resulted in hypothyroidism, for which she has to take thyroid supplement for the rest of her life.
Below is another example of results of an aggressive surgery for a patient with upper neck keloid. The neck keloid was removes for the third time. A skin graft was harvested from the thigh to reconstruct the post-operative defect in the neck. This was followed by radiation. The following images show the outcome of the treatment in this patient.

Scalp Keloids – Acne Keloidalis

Keloids can also form in the lower hair line in the back of the scalp. This condition is known as Acne Keloidalis and is most common among Africans, African Americans and those with thick and super curly hair. Cause of this type of keloid is unknown; however the triggering factor for this keloid is most often skin injury to this part of scalp from razor blades or ingrown hair in patients who are genetically prone to develop this kind of keloid.

Those who notice early stages of this condition must avoid usage of razor blades on their scalp. These keloids are noticeable and cause significant degree of stress and anxiety for the individual.

As depicted below, the size and extent of this kind of keloids varies, from small keloids, to huge and massive keloids.

Chest Wall Keloid

Chest wall is the most common location for development of keloids. The triggering factor is often wounding of the skin, acne and other skin infections or surgery. The keloid shown below was triggered by a minor wounding of the skin from a sharp object injuring the skin. Surgery always results in worsening of the chest lesions. Best treatment option for cases like this are Steroid or chemotherapy injections and cryotherapy. In the case depicted below, the original lesion was removed surgically, which lead to formation of a much larger lesion at the site of surgery.
The size and shape of chest wall lesions vary from patient to patients. Some patients only have one very small spot on their chest wall; while others may have numerous spots.

Chest wall keloids tend to be thicker in African Americans, and thinner and more flat in individuals with light color skin. They tend to be irritated, itch or even become painful. Exercise, running, sweating can result in temporary expansion and enlargement these keloids and make them more symptomatic.

Cryotherapy for chest wall keloids can be painful and has to be done gently and in small segments divided in multiple sessions. The image below shows the extent of the keloid that can be comfortably frozen in one session of cryotherapy. Although the whole keloid can be treated in one session, such a treatment will make most patients quite miserable for 1-2 days.
The video below also shows the extent of the keloid that comfortably frozen in one session of cryotherapy. This patient required local anesthesia in order to be cofortably treated

These keloids should not be treated with radiation therapy, as radiation imposes an unacceptable risk of causing cancers or damage to the heart or thyroid gland. The patient below had surgery followed by radiation therapy to the keloid in her upper chest, lower neck area. The treatment not only did not help her, but resulted in recurrence of a worse keloid. Radiation therapy also caused a permanent damage to her thyroid gland, made her hypothyroid. She will have to take thyroid supplement medications for rest of her life.

Shoulder Area Keloids

Shoulders area is a common location for keloid formation. Shoulder keloids may be triggered by wounding of the skin, acne and other skin infections, or surgery. Perhaps pressure of the straps of heavy bags may also contribute to the wounding of the shoulder skin and trigger keloid formation. The size and shape of shoulder wall keloids vary from patient to patients. Some patients only have few very small keloids on their shoulder; others may have numerous keloid spots or large and massive keloids on their shoulder.

Quite often, keloids that form on the shoulders are numerous and small in size. This specially is the case in individuals with light color skin, Large and bulky keloids of shoulders are often observed in African and African Americans, although they can also develop small keloids on their shoulder. They tend to be irritated, itch or even become painful. Exercise, running, sweating can result in temporary expansion and enlargement these keloids and make them more symptomatic.
Treatment for these keloids has to be planned very carefully. General principles of keloid treatment apply to these keloids as well. With very high rate of recurrence and risk of worsening of keloids after surgery, I favor medical treatment for these keloids and avoid surgery and radiation therapy all together.

Umbilical Keloids

Umbilical keloids, commonly known as Belly Button Keloids develop in the belly button, often subsequent to piercing of this area; or surgery; in individuals who are prone to develop keloids, mostly Africans and African Americans. My personal experience with this type of keloid is that the disease reoccurs after surgery and it responds very well to cryotherapy. Below are a few examples of umbilical keloids.
Case study 3 is a review of case with belly button keloid which I treated with cryotherapy.

Pubic Keloids

Most pubic keloids are triggered by surgery in this region of the body. Pubic keloids are often bulky and can cause stress and anxiety for the individual.
Treatment for the keloids of the pubic area has to be planned very carefully. General principles of keloid treatment also apply to these keloids. With very high rate of recurrence and risk of worsening of keloids after surgery, I favor medical treatment for these keloids and avoid surgery and radiation therapy all together. Radiation therapy should not be used for treatment of pubic keloid due to proximity to pelvic organs, ovaries in women and gonads in men, as well as bone marrow in pelvic bones.
The image above depicts a pubic keloid in a young woman who had aggressive surgery and radiation therapy to her pubic keloid. Not only the treatment did not resolve the keloid issue, it also resulted in worsening of her keloid. We were able to reduce the mass of this keloid with application of crypotherapy.