Clinical Outcome and Quality of Life After a Multimodal Therapy Approach to Ear Keloids.
OBJECTIVE
Keloids are fibroproliferative scars that can cause a huge psychological burden and severe problems for patients, such as depression. Many treatment options exist; however, recurrence rates, especially with monotherapy, remain high.


OBJECTIVE
To investigate the recurrence rate and changes in quality of life after multimodal therapy.


METHODS
A total of 33 patients with 42 auricle keloids (24 female and 9 male patients; mean [SD] age, 27 [17] years) were enrolled in a prospective cohort study and underwent intramarginal keloid excision and multimodal therapy. Patients were observed postoperatively in the outpatient Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Mannheim, from August 1, 2007, through September 30, 2014, with a mean (SD) follow-up of 30 (19) months (through August 31, 2014). A retrospective analysis of clinical outcomes was performed from September 1 through November 15, 2014.


METHODS
Excision followed by 6 intralesional corticosteroid injections at 4- to 6-week intervals and individually customized pressure splints applied at least 5 nights a week for 6 months.


METHODS
Keloid recurrence rate and subjective handling of the pressure splint were evaluated during clinical visits. Quality of life was measured after the end of therapy with a 3-part questionnaire, including the Glasgow Benefit Inventory (GBI).


RESULTS
After excluding 4 patients (with 5 keloids) for nonadherence to treatment, 3 of 37 keloids recurred, for a recurrence rate of 8% among 29 patients. Insecure handling of the pressure splint significantly correlated with a higher relapse rate (mean subjective handling score in patients with a relapse, 3.60; P = .02). Four of 8 patients with recurrent keloids had poor adherence to adjuvant pressure therapy, which suggests an association between keloid recurrence and adherence to adjuvant pressure therapy. Patients received the 3-part questionnaire by mail to collect data on quality of life. Of 43 patients approached, 33 treated with multimodal therapy completed the questionnaire for a return rate of 77%. Improvement in quality of life after keloid treatment was significant in recurrence-free patients, with a mean GBI score of 22.53 (P < .001).


CONCLUSIONS
The present study showed an improvement in quality-of-life scores after multimodal therapy for keloids. Because poor adherence to the use of ear splints correlated with a higher recurrence rate of keloids, efforts are needed to improve adherence and minimize recurrence.


METHODS
3.
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Giessen, Marburg, Germany2Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Mannheim, University of Heidelberg, Mannheim.
Ute
U
Walliczek
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany.
Stephan
S
Engel
Department of Medical Statistics and Biomathematics, University of Heidelberg, Mannheim, Germany.
Christel
C
Weiss
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany.
Christoph
C
Aderhold
Department of Pathology, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany.
Christiane
C
Lippert
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany.
Angela
A
Wenzel
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany.
Karl
K
Hörmann
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Mannheim, University of Heidelberg, Mannheim, Germany.
Johannes David
JD
Schultz
D000328:Adult; D004427:Ear Diseases / Q000628:therapy*; D004431:Ear, External; D005260:Female; D006801:Humans; D007627:Keloid / Q000628:therapy*; D008297:Male; D010349:Patient Compliance; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D013165:Splints; D016896:Treatment Outcome