Comparative evidence regarding the effectiveness of adjuvant intralesional triamcinolone versus radiotherapy for auricular keloids remains limited.
Objective:
To compare adjuvant triamcinolone injection and radiotherapy in preventing recurrence after auricular keloid excision as measured by regrowth of keloid tissue with a minimum follow-up of 6 months.
Methods:
A systematic review and meta-analysis of PubMed, Embase, Cochrane Library, and Scopus identified studies of auricular keloids treated with excision plus adjuvant radiotherapy or triamcinolone. Non-English articles, case series with fewer than 10 patients, and combined treatments were excluded. Risk of bias was assessed using Cochrane Risk of Bias 2.0 and the Newcastle-Ottawa Scale, and pooled recurrence rates were calculated with random-effects models.
Results:
Forty-five studies (1,885 lesions) were analyzed. Overall recurrence was comparable (triamcinolone: 12% [95% CI: 0.06–0.18] vs. radiotherapy: 13% [0.06–0.21]; p = 0.83). Triamcinolone recurrence varied by follow-up (≤1 year: 36% [0.24–0.49] vs. >3 years: 20% [0.11–0.33]; p < 0.001), while radiotherapy remained stable. Subgroup analyses showed no significant differences for injection timing or radiation dose.
Conclusions:
In this study, the findings suggest that radiotherapy provides durable and superior effectiveness per treatment, whereas triamcinolone requires 4–6 monthly injections and shows progressive loss of long-term effectiveness. Individualized treatment selection that prioritizes long-term stability and treatment frequency is recommended.
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References
1.
WangJC, FortCL, HomDB. Location propensity for keloids in the head and neck. Facial Plast Surg Aesthet Med. 2021; 23(1):59–64; doi: 10.1089/fpsam.2020.0106
2.
LimandjajaGC, NiessenFB, ScheperRJ, et al.The keloid disorder: Heterogeneity, histopathology, mechanisms and models. Front Cell Dev Biol. 2020; 8:360; doi: 10.3389/fcell.2020.00360
3.
JfriA, AlajmiA. Spontaneous keloids: A literature review. Dermatology. 2018; 234(3–4):127–130; doi: 10.1159/000491924
4.
TirganMH. Neck keloids: Evaluation of risk factors and recommendation for keloid staging system. F1000Res. 2016; 5:1528; doi: 10.12688/f1000research.9086.2
ShonsAR, PressBH. The treatment of earlobe keloids by surgical excision and postoperative triamcinolone injection. Ann Plast Surg. 1983; 10(6):480–482; doi: 10.1097/00000637-198306000-00008
7.
ChowdriNA, MasaratM, MattooA, et al.Keloids and hypertrophic scars: Results with intra-operative and serial postoperative corticosteroid injection therapy. Australian and New Zealand Journal of Surgery., 1999; 69(9):655–659; doi: 10.1046/j.1440-1622.1999.01658.x
8.
AközT, GideroğluK, AkanM. Combination of different techniques for the treatment of earlobe keloids. Aesthetic Plast Surg. 2002; 26(3):184–188; doi: 10.1007/s00266-002-1490-3
9.
SandersKW, Gage-WhiteL, StuckerFJ. Topical mitomycin C in the prevention of keloid scar recurrence. Arch Facial Plast Surg. 2005; 7(3):172–175.
10.
RosenDJ, PatelMK, FreemanK, et al.A primary protocol for the management of ear keloids: Results of excision combined with intraoperative and postoperative steroid injections. Plast Reconstr Surg. 2007; 120(5):1395–1400; doi: 10.1097/01.prs.0000279373.25099.2a
11.
HamrickM, BoswellW, CarneyD. Successful treatment of earlobe keloids in the pediatric population. J Pediatr Surg. 2009; 44(1):286–288; doi: 10.1016/j.jpedsurg.2008.10.058
12.
JungJY, RohMR, KwonYS, et al.Surgery and perioperative intralesional corticosteroid injection for treating earlobe keloids: A korean experience. Ann Dermatol. 2009; 21(3):221–225; doi: 10.5021/ad.2009.21.3.221
13.
ContinLA, BastaziniI, AlvesCJM, et al.Keloids in the ears: Follow-up of 41 patients who had surgery and intralesional corticosteroid injections. Surgical and Cosmetic Dermatology., 2011; 3(2):109–111.
14.
KhareN, PatilSB. A novel approach for management of ear keloids: Results of excision combined with 5-fluorouracil injection. J Plast Reconstr Aesthet Surg. 2012; 65(11):e315–e317.
15.
De SousaRF, ChakravartyB, SharmaA, et al.Efficacy of triple therapy in auricular keloids. J Cutan Aesthet Surg. 2014; 7(2):98–102.
16.
CarvalhaesSM, PetroianuA, FerreiraMA, et al.Assesment of the treatment of earlobe keloids with triamcinolone injections, surgical resection, and local pressure. Rev Col Bras Cir. 2015; 42(1):9–13; doi: 10.1590/0100-69912015001003
17.
TripoliM, CordovaA, MelloniC, et al.The use of triamcinolone combined with surgery in major ear keloid treatment: A personal two stages approach. Eur J Plast Surg. 2015; 38(3):205–210; doi: 10.1007/s00238-015-1067-4
18.
Aluko-OlokunB, OlaitanAA, MorganRE, et al.Prevention of Earlobe Keloid recurrence after excision: Assessment of the value of presurgical injection of triamcinolone. J Craniofac Surg. 2018; 29(7):e673–e675; doi: 10.1097/scs.0000000000004816
19.
KhalidFA, FarooqUK, SaleemM, et al.The efficacy of excision followed by intralesional 5-fluorouracil and triamcinolone acetonide versus excision followed by radiotherapy in the treatment of ear keloids: A randomized control trial. Burns. 2018; 44(6):1489–1495; doi: 10.1016/j.burns.2018.02.017
20.
MohammadiAA, KardehS, MotazedianGR, et al.Management of ear keloids using surgical excision combined with postoperative steroid injections. World J Plast Surg. 2019; 8(3):338–344; doi: 10.29252/wjps.8.3.338
21.
ChoiYJ, LeeYH, LeeHJ, et al.Auricular keloid management in Asian skin: Clinical outcome of intralesional excision and postoperative triamcinolone acetonide intralesional injection. J Cosmet Dermatol. 2020; 19(11):3041–3047; doi: 10.1111/jocd.13383
22.
AljodahMAA, AlfeehanMJ, Al-ZajraweeMZ. Outcome of recurrent auricular Keloid treatment with a combination of surgical excision and perioperative corticosteroid injection. J Cutan Aesthet Surg. 2021; 14(4):392–396; doi: 10.4103/JCAS.JCAS_186_20
23.
BurusapatC, WanichjaroenN, WongprakobN, et al.The effectiveness of immediate triamcinolone acetonide injection after auricular keloid surgery: A prospective randomized controlled trial. Plast Reconstr Surg Glob Open. 2021; 9(8):e3729; doi: 10.1097/gox.0000000000003729
24.
CerejeiraD, BonitoF, AntónioAM, et al.A 7-year experience with Keloid fillet flap and adjuvant intralesional corticosteroids. J Cutan Aesthet Surg. 2021; 14(2):172–176; doi: 10.4103/jcas.Jcas_170_19
25.
MaedaT, FunayamaE, YamamotoY, et al.Long-term outcomes and recurrence-free interval after the treatment of keloids with a standardized protocol. J Tissue Viability. 2021; 30(1):128–132; doi: 10.1016/j.jtv.2020.11.003
26.
YıldızE. Triple treatment in ear keloids: Comparison of post-excisional intralesional steroid and platelet-rich plasma treatment. Am J Otolaryngol. 2021; 42(3):102935; doi: 10.1016/j.amjoto.2021.102935
27.
DatemaFR, SaridinJ, TimmerFCA, et al.Triple therapy protocol for primary and secondary auricular keloids: A prospective outcome evaluation. Dermatol Surg. 2023; 49(9):838–843; doi: 10.1097/dss.0000000000003867
28.
SreeleshLS, KuttyCKK, PrasanthCC, et al.Intralesional Keloid excision followed by single fraction electron beam radiotherapy and postoperative local steroids: A non-randomized open study on recurrence rate. Indian J Surg. 2023; 85(3):516–521; doi: 10.1007/s12262-022-03511-3
29.
HaeusslerD, HuttemannS, BromJ, et al.Long-term results of a multimodal treatment regimen in patients with auricular keloids. Ear, Nose and Throat Journal., 2025; 104(8):486–492; doi: 10.1177/01455613221133202
30.
OllsteinRN, SiegelHW, GillooleyJF, et al.Treatment of keloids by combined surgical excision and immediate postoperative X-ray therapy. Ann Plast Surg. 1981; 7(4):281–285.
31.
ChaudhryMR, AkhtarS, DuvalsaintF, et al.Ear lobe keloids, surgical excision followed by radiation therapy: A 10-year experience. Ear Nose Throat J. 1994; 73(10):779–781.
32.
RagoowansiR, CornesPG, GleesJP, et al.Ear-lobe keloids: Treatment by a protocol of surgical excision and immediate postoperative adjuvant radiotherapy. Br J Plast Surg. 2001; 54(6):504–508; doi: 10.1054/bjps.2001.3656
33.
MalakerK, ZaidiM, FrankaMR. Treatment of earlobe keloids using the cobalt 60 teletherapy unit. Ann Plast Surg. 2004; 52(6):602–604; doi: 10.1097/01.sap.0000095408.74866.f1
34.
FraunholzIB, GerstenhauerA, BöttcherHD. Results of postoperative (90)Sr radiotherapy of keloids in view of patients’ subjective assessment. Strahlenther Onkol. 2005; 181(11):724–729; doi: 10.1007/s00066-005-1411-x
35.
NarkwongL, ThirakhuptP. Postoperative radiotherapy with high dose rate iridium 192 mould for prevention of earlobe keloids. J Med Assoc Thai. 2006; 89(4):428–433.
36.
BischofM, KrempienR, DebusJ, et al.Postoperative electron beam radiotherapy for keloids: Objective findings and patient satisfaction in self‐assessment. Int J Dermatol. 2007; 46(9):971–975.
37.
van de KarAL, KreulenM, van ZuijlenPPM, et al.The results of surgical excision and adjuvant irradiation for therapy-resistant keloids: A prospective clinical outcome study. Plast Reconstr Surg. 2007; 119(7):2248–2254; doi: 10.1097/01.prs.0000260751.20217.28
38.
ArnejaJS, SinghGB, DolynchukKN, et al.Treatment of recurrent earlobe keloids with surgery and high-dose-rate brachytherapy. Plast Reconstr Surg. 2008; 121(1):95–99; doi: 10.1097/01.prs.0000293755.64918.22
39.
StahlS, BarneaY, WeissJ, et al.Treatment of earlobe keloids by extralesional excision combined with preoperative and postoperative “sandwich” radiotherapy. Plast Reconstr Surg. 2010; 125(1):135–141; doi: 10.1097/PRS.0b013e3181c2a46e
40.
RecalcatiS, CaccialanzaM, PiccinnoR. Postoperative radiotherapy of auricular keloids: A 26-year experience. J Dermatolog Treat. 2011; 22(1):38–42; doi: 10.3109/09546630903460278
41.
OgawaR, HuangC, AkaishiS, et al.Analysis of surgical treatments for earlobe keloids: Analysis of 174 lesions in 145 patients. Plast Reconstr Surg. 2013; 132(5):818e–825e; doi: 10.1097/PRS.0b013e3182a4c35e
42.
LeeSY, ParkJ. Postoperative electron beam radiotherapy for keloids: Treatment outcome and factors associated with occurrence and recurrence. Ann Dermatol. 2015; 27(1):53–58; doi: 10.5021/ad.2015.27.1.53
43.
OgawaR, AkaishiS, DohiT, et al.Analysis of the surgical treatments of 63 keloids on the cartilaginous part of the auricle: Effectiveness of the core excision method. Plast Reconstr Surg. 2015; 135(3):868–875; doi: 10.1097/prs.0000000000000962
44.
LiuCL, YuanZY. Retrospective study of immediate postoperative electron radiotherapy for therapy-resistant earlobe keloids. Arch Dermatol Res. 2019; 311(6):469–475; doi: 10.1007/s00403-019-01922-z
45.
RishiKS, SarkarN, KesariP, et al.Single institution experience of postoperative electron beam radiation therapy in the treatment of keloids. Adv Radiat Oncol. 2021; 6(2):100596; doi: 10.1016/j.adro.2020.10.009
46.
HwangNH, LeeNK, ChaeJH, et al.The efficacy of CT-based conformal electron beam radiation therapy after keloid excision. Dermatol Surg. 2022; 48(4):435–440; doi: 10.1097/dss.0000000000003398
47.
HanSH, HaB, ChangCH, et al.Efficacy of immediate postoperative single fractional 10 Gy radiotherapy for earlobe keloids. J Craniofac Surg. 2024; doi: 10.1097/scs.0000000000010002
48.
LiQ, ChenZ, ZouX, et al.Effectiveness of postoperative superficial radiotherapy following the keloid-cross-flap surgery for auricular keloid: A prospective cohort study. Radiother Oncol. 2024; 199:110425; doi: 10.1016/j.radonc.2024.110425
49.
KangD, HaB, ParkTH. A comparative analysis of postoperative single fraction of 9.5 Gy versus 10 Gy for ear keloids. Dermatol Surg. 2025; 51(2):185–190; doi: 10.1097/dss.0000000000004406
50.
ShinJY, LeeJW, RohSG, et al.A comparison of the effectiveness of triamcinolone and radiation therapy for ear keloids after surgical excision: A systematic review and meta-analysis. Plast Reconstr Surg. 2016; 137(6):1718–1725; doi: 10.1097/PRS.0000000000002165
51.
NachtS, GarzonP. Effects of corticosteroids on connective tissue and fibroblasts. Adv Steroid Biochem Pharmacol. 1974; 4(0):157–187; doi: 10.1016/b978-0-12-037504-2.50007-9
52.
HerskindC, JohansenJ, BentzenSM, et al.Fibroblast differentiation in subcutaneous fibrosis after postmastectomy radiotherapy. Acta Oncol. 2000; 39(3):383–388; doi: 10.1080/028418600750013159
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