Earlobe keloid is one of the most common complication following ear piercing. The keloid usually develops after an episode of wound or skin infection. The keloid tends to grow in size and becomes hard. Sometimes they may symptomatic with itchness and tenderness on palpation. The approach to management of earlobe keloid is usually a combination of surgery and scar treatment thereafter to prevent recurrence.

A surgical excision is recommended as a first step to remove the hard nodular keloid scar. The surgery can be done under local anaesthesia. As much of the keloid scar is removed as possible and the wound closed primarily without much distortion to the earlobe. A clean surgical excision without any bleeding will ensure optimal healing condition for the wound and minimize the risk of recurrence. The union of the wound is achieved after 1 week when the stitches are removed.

One month after the excision when the wound is fully healed and stable, we begin the second step of the scar management with intralesional injection using triamcinolone. We advise gentle massage of the scar with silicone gel at home in between injections. A serial triamcinolone injection is done every 4-6 weekly until the scar remains soft and pliable. Usually most of them can be controlled after 3-5 treatments. There is a 10-20% risk of recurrence of the earlobe keloid.