Judicious management of pinna keloids: our experience with combination therapy


  • Sunil Mathews Department of ENT, INHS Sanjivani, Kochi, Kerala, India http://orcid.org/0000-0002-0789-9923
  • Asha T. Jose Department of Dermatology, St. Thomas Hospital, Chennai, Tamil Nadu, India
  • Varun Gangwar Department of ENT, INHS Sanjivani, Kochi, Kerala, India
  • Arumugam S. Vadivu Department of ENT, MERF, Chennai, Tamil Nadu, India http://orcid.org/0000-0001-5403-7667
  • Raghu Nandhan Department of ENT, MERF, Chennai, Tamil Nadu, India




Pinna, Keloid, Surgical excision, Steroid injection, Combined therapy, Recurrence


Background: Keloids occur as a result of overgrowth of fibrous tissue following healing of a cutaneous injury and they cause aesthetic issues when they appear on the exposed parts of the body, especially the face. Keloids are difficult to treat, with a high recurrence rate. There are several treatment modalities for management of keloids, though no single modality is completely effective. Most commonly used treatment modalities are intra-lesional steroids, surgical excision, pressure application, silicone gel sheets, 5-fluorouracil (5-FU), cryotherapy, radiation therapy, laser therapy or a combination of these modalities. The aim of the study was to analyse the causes of development of keloids on the pinna and evaluated the outcomes of various treatment modalities applied. It focused on assessing the clinical efficacy of combined surgical excision of pinna keloids with serial steroid injections to prevent recurrence, in comparison to monotherapy with intra-lesional steroid injections alone.

Methods: A retrospective review based on medical records was done for 18 patients with keloid of pinna, who were treated with either monotherapy or combination therapy.   

Results: Satisfactory low recurrence rates were observed with meticulous surgical excision followed by serial steroid injections (18.2%), as compared to monotherapy with serial steroid injections alone (71.4%), and these comparative results were statistically significant at p<0.05 in the cohort.

Conclusions: A judicious plan for management for pinna keloids is necessary in order to achieve the best functional and cosmetic outcomes, while reducing the recurrence rates to a minimum. Following a combination of interventions has proved safe and effective for managing this challenging entity.

Author Biographies

Sunil Mathews, Department of ENT, INHS Sanjivani, Kochi, Kerala, India

Department of ENT and Head & Neck Surgery, Classified specialist.

Asha T. Jose, Department of Dermatology, St. Thomas Hospital, Chennai, Tamil Nadu, India

Department of Dermatology, Consultant Dermatologist

Varun Gangwar, Department of ENT, INHS Sanjivani, Kochi, Kerala, India

Department of ENT

Arumugam S. Vadivu, Department of ENT, MERF, Chennai, Tamil Nadu, India

Department of ENT

Raghu Nandhan, Department of ENT, MERF, Chennai, Tamil Nadu, India

Department of ENT


Varma S, Gupta S. Keloid and hypertrophic scar. In: Venkataram M, eds. Textbook on Cutaneous and Aesthetic Surgery. 1st ed. New Delhi: Jaypee Brothers Medical Publishers; 2012: 498-513.

Bayat A, Arscott G, Ollier WE, McGrouther DA, Ferguson MW. Keloid disease: clinical relevance of single versus multiple site scars. Br J Plast Surg. 2005;58(1):28-37.

Sousa RF, Chakravarty B, Sharma A, Parwaz MA, Malik A. Efficacy of triple therapy in auricular keloids. J Cutan Aesthet Surg. 2014;7(2):98-102.

Robles DT, Moore E, Draznin M, Berg D. Keloids: pathophysiology and management. Dermatol Online J. 2007;13(3):9.

Marneros AG, Krieg T. Keloids--clinical diagnosis, pathogenesis, and treatment options. J Dtsch Dermatol Ges. 2004;2(11):905-13.

Ogawa R, Akaishi S, Izumi M. Histologic analysis of keloids and hypertrophic scars. Ann Plast Surg. 2009;62(1):104-5.

Nast A, Eming S, Fluhr J, Fritz K, Gauglitz G, Hohenleutner S, et al. German S2k guidelines for the therapy of pathological scars (hypertrophic scars and keloids). J Dtsch Dermatol Ges. 2012;10(10):747-62.

Reish RG, Eriksson E. Scar treatments: preclinical and clinical studies. J Am Coll Surg. 2008;206(4):719-30.

Rosen DJ, Patel MK, Freeman K, Weiss PR. A primary protocol for the management of ear keloids: results of excision combined with intraoperative and postoperative steroid injections. Plast Reconstr Surg. 2007;120(5):1395-400.

Shin JY, Lee JW, Roh SG, Lee NH, Yang KM. A Comparison of the Effectiveness of Triamcinolone and Radiation Therapy for Ear Keloids after Surgical Excision: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2016;137(6):1718-25.

Gupta S, Sharma VK. Standard guidelines of care: Keloids and hypertrophic scars. Indian J Dermatol Venereol Leprol. 2011;77(1):94-100.

Hao YH, Xing XJ, Zhao ZG, Xie F, Hao T, Yang Y, et al. A multimodal therapeutic approach improves the clinical outcome of auricular keloid patients. Int J Dermatol. 2019;58(6):745-9.

Ogawa R, Miyashita T, Hyakusoku H, Akaishi S, Kuribayashi S, Tateno A. Postoperative radiation protocol for keloids and hypertrophic scars: statistical analysis of 370 sites followed for over 18 months. Ann Plast Surg. 2007;59(6):688-91.

Lyu A, Xu E, Wang Q. A retrospective analysis of surgical resection of large ear keloids. Australas J Dermatol. 2019;60(1):29-32.

Asilian A, Darougheh A, Shariati F. New combination of triamcinolone, 5-Fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Dermatol Surg. 2006;32(7):907-15.

Yamamoto T. Bleomycin and the skin. Br J Dermatol. 2006;155(5):869-75.






Original Research Articles