Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR

Summary

Introduction: Keloids are benign tumors arising from abnormal healing of the skin, and there are several procedures available for their treatment.

Objective: The objective of this study was to evaluate the outcomes of patients undergoing treatment of keloids after ear, nose, and throat (ENT) surgeries at our service center.

Method: We conducted thorough, retrospective and prospective analysis of records of patients undergoing treatment of retroauricular keloids at our center.

Results: Nine patients were evaluated, and 6 underwent resection and adjuvant beta-therapy, 2 underwent resection with local application of corticosteroids, and only 1 underwent resection without adjuvant therapy. There was no recurrence of keloids in patients that were treated with beta-therapy in the early postoperative period. One patient had relapsed despite corticosteroid administration and late beta-therapy.

Discussion: Several techniques have been used for the treatment of retroauricular keloids, and beta-therapy is thought to yield the best results, followed by the use of intralesional corticosteroids.

Conclusion: Treatment of retroauricular keloids remains a challenge. While new techniques are being developed, resection followed by early beta-therapy is still the best treatment option.

Resumo

Introdução: Queloides são tumores benignos resultantes de cicatrização anômala da pele, sendo que existem diversos procedimentos disponíveis para o seu tratamento.

Objetivo: O objetivo deste trabalho é avaliar os resultados de pacientes submetidos a tratamento de queloides retroauriculares após cirurgias otorrinológicas em nosso serviço.

Método: Estudo retrospectivo e prospectivo, através de análise de prontuários, dos pacientes submetidos a tratamento de queloides retroauriculares em nosso serviço.

Resultados: Nove pacientes foram avaliados, sendo que 6 foram submetidos a ressecção e betaterapia adjuvante, 2 foram submetidos a ressecção mais aplicação de corticoide local, 1 foi submetido apenas a ressecção sem terapia adjuvante. Não houve recidiva nos casos tratados com betaterapia no pós-operatório precoce, 1 paciente apresentou recidiva mesmo com corticoterapia e betaterapia tardia.

Discussão: diversas técnicas tem sido utilizadas para tratamento dos queloides retroauriculares, sendo que a betaterapia é considerada a com melhores resultados, seguida pela utilização de corticoides intralesionais.

Conclusão: o tratamento dos queloides retroauriculares continua um desafio. Enquanto novas técnicas não são desenvolvidas, a ressecção seguida de betaterapia precoce ainda é a melhor opção.

Keywords

keloid - treatment outcome - ear

Palavras-chave

queloide - terapêutica - orelha

• Bibliographic References

• 1 Viani GA, Stefano EJ, Afonso SL, De Fendi LI. Posoperative strontium-90 brachytherapy in the prevention of keloids: results and prognostic factors. Int J Radiation Oncology Biol Phys 2009; 73 (5) 1510-1516
• 2 Froelich K, Staudenmaier R, Leinsasse N, Hagen R. Therapy of auricular keloids: review of different treatmente modalities and proposal for a therapeutic algorithm. Eur Arch Otorhinolaryngol 2007; 264: 1497-1508
• 3 Correspondence and Comunication. Use of colchicine to prevent recurrence of ear keloids. A new approach. Journal of Plastic, Recontructive and Aesthetic Surgery 2010; 63: e650-e652
• 4 Oliveira Jr B, Lastoria JC, Pereira HR, Silveira LVA, Oliveira LP, Stolf HO. Estudo comparativo entre o tratamento radioterápico com elétrons e betaterapia, após cirurgia de quelóides. Surgical & Cosmetic Dermatology 2009; 1 (2) 53-57
• 5 Durani P, Bayat A. Levels of evidence for the treatment of keloid disease. Jouranl of Plastic, Reconstructive and Aesthetic Surgery 2008; 61: 4-17
• 6 Garg MK, Weiss P, Sharma AK, Gorla GR, Jaggernauth W, Yaparpalvi R, Delrowe J, Beitler JJ. Adjuvant high dose brachytherapy (Ir-192) in the managemente of keloids which have recurred after surgical excision and external radiation. Radiotherapy and Oncology 2004; 73: 233-236
• 7 Veen RE, Kal HB. Postoperative high-dose-rate brachytherapy in prevention of keloids. Int. J. Radiation Oncology Biol Phys 2007; 69 (4) 1205-1208
• 8 Stahl S, Barnea Y, Weiss J, Zaretski A, Leshem D, Miller E, Shafir R, Ben-yosef R, Gur E. Treatment of earlobe keloids by extralesional excision combined with preoperative and postoperative “sandwich” radiotherapy. Plastic and Reconstructive Surgery January 2010; 125 (1)
• 9 Huhn JL, Johnson EL, St Clair W. Adjuvant radiation of bilateral postauricular keloids: an illustration of technique. Medical dosimetry 2007; 32 (4) 278-280
• 10 Hochman B, Locali RF, Oliveira LQR, Ferreira LM. Disfunções cicatriciais hiperproliferaticas: Quelóide. Estima 2004; 4 (4) 33-39
• 11 Ragoowansi R, Cornes PGS, Glees JP, Powell BW, Moss LH. Ear-lobe keloids: treatment by a protocol of surgical excision and immediate postoperative adjuvant radiotherapy. British Journal of Plastic Surgery 2001; 54: 504-508
• 12 Bermueller C, Rettinger G, Keck T. Auricular keloids: treatment and results. Eur Arch Otorhinolaryngol 2010; 267: 575-580
• 13 Liu MF, Yencha M. Cushing's syndrome secondary to intralesional steroid injections of multiple keloids. Otolaryngology–Head and Neck Surgery 2006; 135: 960-961
• 14 Gao Z, Wu X, Song N, Zhang L, Liu W. Differential expression of growth differentiation factor-9 in keloids. Burns 2010;
• 15 Ulrich D, Ulrich F, Unglaub F, Piatkowski A, Pallua N. Matrix metalloproteinases and tissue inhibitors of metalloproteinases in patients with different types of scars and keloids. Journal of Plastic, Reconstructive & Aesthetic Surgery 2010; 63: 1015-1021