Treatment of Ear Keloids in a 28-Year-Old Female: Intralesional Kenalog and 5-FU Therapy
by: Dr. Ashley Baldree
Case Overview
A 28-year-old female presented to Village Dermatology in Katy, Texas, with long-standing scars on both earlobes. The patient described the lesions as stable but cosmetically bothersome. She reported that the right earlobe keloid was larger than the left and had been present for several years.
The patient was a non-smoker, reported no unhealthy alcohol use, and had no systemic symptoms. She sought medical evaluation and treatment options for her bilateral ear keloids.
Clinical Examination
A focused examination was performed on both ears using dermatoscopy. The patient appeared well-developed and in no acute distress. On exam, there were firm, raised, telangiectatic nodules consistent with keloids on both anterior earlobes, with the right side more prominent.
Diagnosis
Keloid (L91.0) – A benign fibrous overgrowth of scar tissue extending beyond the original wound boundary, commonly caused by trauma, piercings, or previous surgery.
Management Plan
1. Intralesional Kenalog (ILK) with 5-Fluorouracil (5-FU)
After discussing multiple treatment options, including intralesional corticosteroid injections, surgical excision, topical imiquimod, and radiation therapy, the patient elected to begin treatment with intralesional Kenalog (triamcinolone acetonide) in combination with 5-fluorouracil (5-FU).
Medication: Kenalog (20 mg/cc) mixed with 5-FU
Total Volume Injected: 1.0 cc
Injection Sites: Right and left anterior earlobes
Administered by: AB
Procedure Details: The lesions were injected using sterile technique after discussing risks such as atrophy, hypopigmentation, and recurrence.
This Kenalog + 5-FU combination therapy works synergistically to reduce inflammation, soften keloid tissue, and prevent regrowth—offering superior outcomes compared to steroid injections alone.
2. Silicone Sheet Therapy
The patient was advised to apply silicone gel sheets daily to maintain pressure and hydration over the treated area. Silicone sheeting can help flatten and fade keloids over time by regulating collagen production.
3. Education and Counseling
The patient received detailed counseling regarding:
Nature of Keloids: Overactive scar formation that can cause thickened, itchy, or tender tissue.
Treatment Expectations: Gradual improvement over multiple sessions; some residual firmness may persist.
Future Considerations: Excision may be considered in the future, ideally in combination with ongoing ILK injections or postoperative radiation to reduce recurrence risk.
Follow-Up: Scheduled in 6 weeks for reassessment and possible repeat injections.
Discussion
Keloids are particularly common in individuals with ear piercings or previous trauma to the lobes. They can be cosmetically distressing and refractory to treatment if not managed with a multimodal approach.
At Village Dermatology in Katy and Houston, Texas, our dermatologists tailor treatment plans using intralesional corticosteroids, 5-FU, silicone therapy, and advanced surgical techniques to minimize recurrence and optimize cosmetic outcomes.
Conclusion
This case demonstrates the effective use of intralesional Kenalog with 5-FU in managing earlobe keloids. Early intervention, consistent follow-up, and patient adherence to silicone therapy are key to achieving long-term results.
Residents of Katy and Houston, TX experiencing thickened or painful scars can schedule a consultation at Village Dermatology for expert evaluation and personalized treatment.
