Understanding and Comparing Current Practice for Ear Keloid Scars: A Narrative Systematic Review

A keloid scar is a benign fibroproliferative disorder that is characterized by excessive tissue growth beyond the original wound. The psychosocial and surgical challenges that arise can present potentially devastating long-term consequences for patients, particularly in demographics with a high incidence of keloid scar formation. Considering the high incidence of keloids with an estimated 11 million cases annually, particularly in those of Asian and African backgrounds, an understanding of their exact pathophysiology remains challenging. Piercing-induced keloids of the ear are a common cause of ear keloids, yet the exact mechanism and optimal treatments are of considerable debate. This narrative review aims to evaluate current treatment modalities for ear keloids, focusing on their association with ear piercings and the implications for management. A systematic review of Medline, Embase, and Mendeley identified 26 studies, covering a range of surgical and non-surgical treatment methods, indicating a considerable recurrence rate, with an average of 20.3%. Surgical excision remained the primary treatment modality, which was often accompanied by adjunctive therapies such as steroid injections and radiotherapy. Fractional carbon dioxide laser therapy may also be a useful treatment modality with fewer potential complication risks. Overall, the findings identified significant variability in treatment protocols and outcomes, underscoring the need for personalized approaches based on keloid characteristics and patient preferences. Ultimately, the review highlights the importance of further research to establish standardized treatment protocols for ear keloid scars and to understand the role of piercing-specific pathophysiology in improving patient outcomes.