title: Collagenase followed by compression for the treatment of earlobe keloids.
abstract: BACKGROUND
  Many therapeutic options are available for treating keloids, but success rates vary widely, and the keloids often recur. The Food and Drug Administration has recently approved intralesional collagenase for the treatment of Dupuytren's contracture. This medication has not been explored for the treatment of earlobe keloids, a common problem.
  
  
  OBJECTIVE
  To evaluate the safety and clinical efficacy of intralesional collagenase followed by compression for the treatment of earlobe keloids.
  
  
  METHODS
  Six earlobe keloids in six patients were injected with a commercial collagenase preparation. Study participants were asked to use compression earrings daily thereafter. Patients were examined and photographed 1 day, 2 weeks, 4 weeks, 10 months, and 12 months after injection. Adverse events were assessed at each visit, and the keloids were measured and photographed.
  
  
  RESULTS
  All patients had a decrease in the size of their earlobe keloid by an average of 50% (p = .02). Three of the six participants chose to have their earlobe keloids surgically excised for cosmetic reasons 6, 8, and 11 months after enrollment, so measurements for data analysis for these patients were taken after only 1, 1 and 10 months. All participants returned for follow-up at the last study visit 1 year after study commencement. The three patients who completed the study were pleased with the improvement of their earlobe keloid, although complete clearance was not achieved. Side effects included injection site swelling, tenderness, and one ulceration that spontaneously resolved within 2 weeks.
  
  
  CONCLUSIONS
  Intralesional collagenase followed by compression appears to be a safe and modestly effective treatment for earlobe keloids. This approach warrants further investigation in larger studies with longer follow-up in motivated patients who decline surgical excision.
authors.affiliation: Department of Dermatology, School of Medicine, Boston University, Boston, Massachusetts; Laser & Skin Surgery Center of New York, New York, New York.
authors.forename: Yoon-Soo Cindy
authors.initials: YS
authors.lastname: Bae-Harboe
authors.forename: Jens Erik
authors.initials: JE
authors.lastname: Harboe-Schmidt
authors.forename: Emmy
authors.initials: E
authors.lastname: Graber
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Gilchrest
mesh_terms: D000328:Adult; D017364:Collagenases / Q000009:adverse effects / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004431:Ear, External; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D007627:Keloid / Q000473:pathology / Q000628:therapy*; D008297:Male; D017060:Patient Satisfaction; D010865:Pilot Projects; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D017364:Collagenases