Recurrent Auricular Keloids during Pregnancy

A keloid is one of the most frustrating clinical problems in wound healing. Keloids form following dermal injury and exhibit exuberant and indefinite growth of collagen. Many theories have been propounded in trying to explain some of the vagaries of keloids. From one of the theories, keloid scars may develop at any age; patients between 10 and 30 years of age (reproductive age) are the most affected population, and there may be a hormonal influence because keloid scars tend to grow during puberty and pregnancy, and resolve during menopause [1]. In our experience, pregnancy-related recurrent keloids have arisen from the ear, despite the patient’s successful completion of our treatment. The case presented here illustrates the possible connection between keloid formation and hormonal changes during pregnancy. A 27-year-old pregnant female visited our clinic due to progressive growth of her left auricular keloid. Three years prior to the visit, she had developed a scar on her left auricle after treatment for acute inflammation caused by an ear piercing procedure at a nonmedical institute. She showed no other particular medical history. She also reported that the lesions appeared and became larger after the first trimester of pregnancy (Fig. 1). On physical examination, the left auricle showed a keloid of nearly circular appearance, approximately 2.2 cm in diameter, with a mean thickness of about 1.5 cm, extending from the superior pole of the auricle down to the middle ear. The skin surface of the keloid was irregular and showed dispersed minute superficial ulcer with itching sensation. Because of pregnancy, we waited to perform a core extirpation of the keloid until 6 months after delivery. Compression on the auricle was performed postoperatively in combination with the application of scar care ointment. Even after 1 month, the clinical result remained obviously acceptable where the core extirpation had been performed. Two years later, the patient returned with a huge enlargement of the left auricular keloid. Similar to the previous keloid, it appeared and became bigger (2.2× 1.7 cm) simultaneously with child bearing. She remembered that the keloid started to enlarge rapidly in her first trimester of her second pregnancy, with mild itching and redness. She was asked to return after her delivery (Fig. 2).