April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Reprinted by permission of J Pediatr Surg. 2019 Jul 24; doi: 10.1016/j.jpedsurg.2019.07.006. [Epub ahead of print].

YJPSU-59275; No of Pages 4

Journal of Pediatric Surgery xxx (xxxx) xxx

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Journal of Pediatric Surgery

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Pediatric earlobe keloids: Outcomes and patterns of recurrence ☆ Faraz A. Khan ⁎ , Natalie A. Drucker, Shawn D. Larson, Janice A. Taylor, Saleem Islam Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Rd. P.O. Box 10019, Gainesville, FL, USA

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Purpose: Keloids occur as a result of abnormal wound healing and as many as 70% of keloids and hypertrophic scars affect the pediatric population. Earlobe keloids, similar to lesions elsewhere in the body, remain a challeng- ing problem given the high rates of recurrence and lack of consensus regarding treatment strategy. This study aims to evaluate the outcomes and patterns of recurrences following treatment of earlobe keloids in a large co- hort of pediatric patients to facilitate identi fi cation of the optimal treatment strategy. Methods: All pediatric patients who underwent surgical therapy for earlobe keloids over a 10-year period (2004 – 2015) were identi fi ed and demographic, clinical and outcomes data were collected. A follow-up phone surveywas administered to assess rates of long-term recurrence and overall satisfactionwith the treatment strat- egy. Data analysis was performed using Student's t-test and Fisher's exact as appropriate. Results: A total of 94 patients with 135 keloids were identi fi ed. Mean age was 14 years with slight preponderance of females (52%) and a majority (75%) of the patients were African American (AA). Mean keloid size was 2.4 cm (0.25 – 11 cm) with ear piercing being the most common inciting etiology. Excision with steroid injection (59%) was the most frequent treatment approach followed by excision alone (25%). During a median follow up of 2 years, keloid recurrence occurred in 27 (28.7%) patients, 19 (70.4%) underwent additional therapy with 10 (52.6%) re-recurrences noted. Median time to recurrence was 23 months, with a slightly higher recurrence rate in AA patients (32%; p = 0.26) and in those age b 10 years (50%; p = 0.11). Conclusion: This represents the largest series of earlobe keloids treatment in children. Our data suggest that recur- rence rates are unaffected by the age at excision and race of the patient. Moreover, adjuncts to excisional therapy such as steroid injection, compression therapy and radiation also did not appear to in fl uence recurrence. Given the pattern of recurrences studies with longer term follow-up are needed to assess the ef fi cacy of treatment strat- egies. Type of study: Case series. Level of evidence: IV © 2019 Elsevier Inc. All rights reserved.

Article history: Received 10 September 2018 Received in revised form 23 June 2019

Accepted 15 July 2019 Available online xxxx

Key words: Earlobe Keloids Pediatric Recurrence

Any injury to the deep dermis irrespective of the mechanism is followed by wound healing which clinically manifests with the forma- tion of a scar. [1] While scars are typically classi fi ed based on morpho- logical appearance or histopathology, in essence clinically the appearance and characteristics of a patient's scar are simply the end- point of genetic and environmental factors affecting the wound healing process. [2] Globally, approximately 100 million individuals per year ac- quire a scar following surgical/traumatic insult, and approximately 15 million are subsequently complicated by keloids and hypertrophic scars which are because of excess collagen deposition. Almost 70% of ke- loids or hypertrophic scars are noted to occur in children. [2] ☆ Funding Disclosure and Con fl icts of Interest: No external funding was secured for this study. The authors have no fi nancial relationships or any other con fl icts of interest to disclose. ⁎ Corresponding author. Tel.: +1 352 265 8800. E-mail addresses: dr.farazali@gmail.com (F.A. Khan), ndrucker@iupui.edu (N.A. Drucker), shawn.larson@surgery.u fl .edu (S.D. Larson), Janice.taylor@surgery.u fl .edu (J.A. Taylor), Saleem.islam@surgery.u fl .edu (S. Islam).

Hypertrophic scars by de fi nition remain within the boundaries of the original injury, whereas keloids extend beyond and frequently have a delayed onset as compared to hypertrophic scars. Keloids dispropor- tionately occur in dark skinned individuals, are associated with a famil- ial history, and are related to hormonal changes associated with puberty. [2,4,5] These lesions are frequently symptomatic and can be as- sociated with pruritus, pain, and tenderness. [13] Moreover, there is sig- ni fi cant social and psychological impact on the affected patient. [6] Certain anatomic areas of the body such as the chest, shoulders, neck and ears appear to be more predisposed to the development of keloids and have important cosmetic signi fi cance. [7,12] Given the frequency of earlobe piercing associated with an approximately 2.5% risk of keloid development, earlobes are one of the most frequent locations these le- sions are seen in pediatric patients. [8,9] Earlobe keloids, similar to lesions elsewhere in the body, remain a challenging problem to manage given the high rates of recurrence and lack of consensus regarding treatment strategy. Numerous treatment strategies have been proposed including surgical excision, intralesional

https://doi.org/10.1016/j.jpedsurg.2019.07.006 0022-3468/© 2019 Elsevier Inc. All rights reserved.

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