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DOI: 10.7162/S1809-97772012000200007
Original Article
SUMMARY
RESUMO
Int. Arch. Otorhinolaryngol., So Paulo - Brazil, v.16, n.2, p. 195-200, Apr/May/June - 2012.
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Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR.
INTRODUCTION
Keloids are benign fibrous tumors (1) that emerge
as reactions to abnormal skin healing. Keloids develop due
to the response of connective tissue to trauma and
inflammation, burns, piercing, or surgeries in areas of high
tension in the body, in predisposed individuals (1, 2).
Keloids may occur at any age regardless of gender;
however, they tend to occur more frequently in individuals
between 10 and 30 years of age. There is a higher
prevalence in patients with dark skin and in the areas of the
ear, shoulder, and chest (3).
The keloid appears as a thick and smooth (2) scar that
extends beyond the original wound and may cause increased
tension on the skin, leading to local deformation (3). Keloids
usually start to grow within the first year after the trauma
occurs, and they rarely regress on their own (2). The main
symptoms associated with keloids are tingling, burning, and
itching, leading to functional changes and discomfort (1).
At the cellular level, the characteristics of keloids
include uncontrolled synthesis and deposition of excessive
collagen and glycoproteins (2). It has been demonstrated
that keloids are composed of polyclonal fibroblasts that are
intrinsically normal, but exhibit abnormal responses to
extracellular signals, thus resulting in excessive collagen
production and decreased degradation of fibrotic scar
tissue (1).
Differential diagnosis of keloids is made with
hypertrophic scars, which are scars confined to the margins
of the original wound and often show spontaneous regression
(2). This distinction is very important, as these entities
require different treatment strategies.
Carvalho et al.
RESULTS
We evaluated 9 patients (13 ears), aged between 9
and 27 years, including 6 men and 3 women.
Four patients developed keloids after otoplasty, 2
after tympanoplasty, 1 after mastoidectomy, 1 after surgical
correction of a congenital malformation (preauricular sinus),
and 1 after a surgery that was performed at another
institution (and thus cannot be described).
Patients underwent 6 sessions of beta-therapy at the
Erasto Gaertner Hospital, and 2 patients had started taking
corticosteroids and received beta-therapy late.
Two patients received only local corticosteroids
(betamethasone 3mg, Celestone soluspan), and 1 patient
did not undergo adjuvant therapy since the keloid was very
small.
METHOD
This study was approved by the Ethics Committee
on Human Research of the HC/UFPR.
Int. Arch. Otorhinolaryngol., So Paulo - Brazil, v.16, n.2, p. 195-200, Apr/May/June - 2012.
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Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR.
Table 1. Results.
Patient
Previous surgery
1
Bilateral after otoplasty
2
Bilateral after tympanoplasty
3
4
5
6
7
Treatment
Resection + betatherapy + ointment**
Resection + betatherapy + ointment**
Resection unilateral (longer side) + betatherapy
Resection + CTC*** + ointment**
Resection + CTC*** + betatherapy *+ ointment**
Resection + CTC***
Resection + re making of sutures master of Mustard
+ betatherapy
Resection only
Resection + betatherapy + CTC***
Carvalho et al.
Recurrence
no recurrence
no recurrence EL
mild hypertrophy ER
no recurrence
no recurrence
recurrence
no recurrence
no recurrence
no recurrence
no recurrence
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Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR.
Carvalho et al.
DISCUSSION
Keloids are a problem that affects the quality of life
of patients, not only for aesthetic reasons, but also primarily
by the associated symptoms (itching, pain, burning
sensation, and intolerance to some tissues) (4), making it
necessary to utilize an effective, specific treatment approach.
The most common difficulty in treating keloids is
their recurrence after surgical excision. To solve this problem,
various types of adjuvant treatments have been developed.
The various treatment options used to prevent the
recurrence of keloids include continuous pressure after
surgery, application intralesional steroids, use of a carbon
dioxide laser, application of silicone gel, administration of
retinoic acid, covering with silicone gel (1), cryosurgery,
use of chemotherapeutic agents (5-fluorouracil), intralesional
interferon administration, radiation therapy, and others (5).
However, there is no solid evidence that these methods
are effective in prevention of keloid recurrence, and
radiotherapy is the only treatment shown to be effective
in preventing the formation of keloids (1).
It is important to remember that the keloid that is
formed is not radiosensitive, but the fibroblasts in the
recently scarred areas are; therefore, it is necessary to
apply the radiation to the connective tissue in the immediate
postoperative period, during the cellular proliferation and
differentiation stage, and before the fibrotic tissue has
formed (4).
The radiotherapy techniques that are typically
employed include external radiotherapy with superficial
X-rays, brachytherapy with strontium (Sr90) or electron
beams, low-dose brachytherapy (1), high-dose
brachytherapy (6,7), and radiation associated with pre or
postoperative therapy (8).
The mechanism by which radiation acts is not well
understood, but it is believed that radiation destroys
fibroblasts, which are replaced by cells from the blood
stream that migrate from other tissues (1).
Int. Arch. Otorhinolaryngol., So Paulo - Brazil, v.16, n.2, p. 195-200, Apr/May/June - 2012.
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Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR.
Carvalho et al.
Int. Arch. Otorhinolaryngol., So Paulo - Brazil, v.16, n.2, p. 195-200, Apr/May/June - 2012.
199
Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR.
Carvalho et al.
CONCLUSION
The treatment of retroauricular keloids presents
many difficulties, either with regard to the treatment of
keloid itself or due to location.
In our department, we obtained the best results
when surgical excision was combined with beta-therapy
that was started soon after surgery.
It is expected that the development of other nonsurgical therapies will facilitate the treatment of retroauricular
keloids and other keloids as well.
BIBLIOGRAPHIC REFERENCES
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Therapy of auricular keloids: review of different treatmente
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of keloid disease. Jouranl of Plastic, Reconstructive and
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