Surgical management of auricular keloids: a clinical study on strategies to minimize recurrence conducted in South Korea

Background Ear keloids are benign, fibroproliferative scars characterized by excessive collagen deposition, often triggered by ear piercing or trauma. Their high recurrence rates and the anatomical constraints of the ear complicate treatment, leading to cosmetic and psychological distress.Methods Between February 2023 and April 2025, 58 patients underwent surgical excision of ear keloids, including complete resection of the piercing channel and exclusion of keloid-covered skin for reconstruction. Procedures were performed under local anesthesia, using wedge or elliptical excisions tailored to the keloid location. Postoperative management included intralesional triamcinolone (40 mg/mL) at suture removal and oral tranilast for 1 month, with additional injections administered for suspected recurrence. Patients were followed up monthly.Results A total of 63 keloid lesions were treated in 58 patients. Recurrence occurred in three patients (5.2%), all of whom were managed with additional injections or revision surgery. Complications included one case of wound dehiscence and one hematoma. The mean patient age was 28.2 years, and 94.8% were female. Most keloids (65.1%) were located on the helix or antihelix, primarily caused by piercing.Conclusions Wide excision avoiding keloid-covered skin, combined with intralesional triamcinolone and oral tranilast, achieved a low recurrence rate (5.2%) for ear keloids. This multimodal approach effectively addresses recurrence risk while preserving aesthetic outcomes, although long-term follow-up is necessary to confirm the durability of results.