These extensive, smooth, irregular masses of pigmented tissue on the earlobes of a 28-year-old woman are keloids. The patient had her ears pierced at age 6 years; the masses began to develop when she was about 9 to 10 years old. The right earlobe mass arose first and is larger. She had one other keloid of 1 cm on her chest that had developed after a scratch. She denied any other skin lacerations or incisions.
Keloids result from excessive collagen formation in the corium that occurs during connective tissue repair. They extend beyond wound margins and usually do not regress. In contrast, hypertrophic scars remain confined to the area of tissue injury and typically regress over time. Microscopically, large collagen bundles are present in keloids but not in hypertrophic scars.1
Keloids are most common on the shoulders and back; however, they may occur on any body surface and can develop years after the injury. Persons of African American descent are more susceptible to keloids than are persons of other races.
Treatment options include intralesional corticosteroid injections with or without surgical excision, cryotherapy, silicone gel sheeting, radiation therapy with surgery, 5-fluorouracil intralesional injections, bleomycin penetration through the dermis, and pulsed dye laser.1 This patient did not want to have the keloids treated.
1. Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 4th ed. Philadelphia: Mosby; 2004:709.