A 28-year-old man comes to the physician due to pain in his left earlobe. He pierced his earlobe to be able to wear earrings 3 months ago. The puncture wound never healed well, and he has experienced itching and sharp pains there ever since. His medical history is otherwise unremarkable. He is currently not taking any medications. On physical examination, there is excessive scar tissue formation on the earlobe at the site of the piercing as shown. Prior to treatment, what potential complications should be reviewed with the patient?

Question

A 28-year-old man comes to the physician due to pain in his left earlobe.  He pierced his earlobe to be able to wear earrings 3 months ago.  The puncture wound never healed well, and he has experienced itching and sharp pains there ever since.  His medical history is otherwise unremarkable.  He is currently not taking any medications.  On physical examination, there is excessive scar tissue formation on the earlobe at the site of the piercing as shown.  Prior to treatment, what potential complications should be reviewed with the patient?

Quizplus · Accepted Answer

Explanation: Intralesional glucocorticoid injection is the preferred treatment for established keloids in most cases. The success rate is high, but >30% of patients may require additional interventions such as surgical excision. In addition, patients should be advised that a significant number may experience recurrent keloid formation that will require additional treatment in the future. (Choice A) Fungal meningitis has been reported in association with injection of contaminated glucocorticoid preparations. However, these episodes are very rare and are primarily associated with intra-articular, epidural, and paraspinal glucocorticoid injection. (Choice B) Hypopigmentation is common after cryosurgical keloid treatment and limits the appeal of this treatment option for darker-skinned patients. It is seen less frequently following glucocorticoid injection and is primarily associated with higher doses. (Choice C) Silicone gel sheeting is frequently used for treatment of keloids. Local dermatitis is the most frequent adverse effect, and often necessitates discontinuation of this treatment. (Choice D) Malignant conversion is not frequently seen with keloids (with or without glucocorticoid treatment), but concern for malignancy limits the use of radiation therapy as a treatment modality for keloids. Educational objective: Intralesional glucocorticoid injection is the preferred treatment for keloids in most cases. However, treatment failure is common and additional interventions may be needed. Later recurrence of keloids is also common.

A 28-Year-Old Man Comes to the Physician Due to Pain