General dermatology: Treating a large earlobe keloid. For medical education- NSFE.

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For medical education- NSFE. This patient has a pretty large keloid on his left earlobe, triggered by an ear piercing.
Keloids occur most often on the earlobes, the chest, back, and upper arms. It is when scar tissue from an episode of “trauma” gets hyperexcited and grows beyond the bounds of the original wound. Usually a person knows when their keloid is active because it itches or is painful
Treatment is difficult and recurrence is common. Simply excising a keloid is not usually recommended because “trauma” itself is definitely a causative factor
Here I inject the keloid first with intralesional corticosteroids to “calm the scar cells down” – this often leads to softening and shrinkage of the keloid, but multiple treatments are needed. Then I used a Cryoshape cannula, inserted into the center of the keloid and connected to liquid nitrogen, which is extremely cold, almost 300 degrees below. This cryoshape freezes the keloid from the inside out, in the hopes of destroying the cells that are overproducing.
Patient is not in any pain because we number the area around the keloid before treatment. The keloid will ideally turn black and shrink or fall off but this can take a few weeks to a few months.

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