Treatment of earlobe keloids with surgery plus adjuvant intralesional verapamil and pressure earrings

Abstract

Treatment for keloids remains less than ideal. Previous discouraging results prompted a change in the author's standard treatment for keloids to surgery plus adjuvant intralesional verapamil and pressure earrings. Intralesional verapamil (2.5 mg per milliliter) was administered 7 to 14 days after keloid removal and again approximately 1 month after removal when possible. Between 0.5 ml and 2.0 ml was administered each time, depending on the size of the keloid. Patients were instructed to wear pressure earrings essentially continuously for a minimum of 6 months after excision. Thirty-five African American patients with 45 earlobe keloids were treated with this regimen. Information regarding recurrence was obtained by follow-up, mail, or phone call from 31 patients (89%) with 40 keloids (89%). Minimum follow-up for inclusion was 6 months and average follow-up was 28 months. Twenty-two keloids (55%) in 16 patients (52%) were cured by this treatment modality. There were no significant differences in recurrence rates related to sex, age, keloid size, length of time the keloid was present, how long the ears had been pierced, and how many verapamil injections were received. There was a trend toward an increased recurrence rate for previously treated keloids. Though not optimal, this regimen is superior to some previously evaluated regimens.