Cryotherapy: A Successful Monotherapy for Earlobe Keloids

@#A keloid represents an excessive overgrowth of skin beyond the boundaries of an injury. Earlobe keloids usually follow ear piercing and can become large, sometimes producing remarkable disfigurement. Surgical excision, pressure dressing, intralesional corticosteroid injection, cryosurgery, radiation, and lasers have all been used to treat earlobe keloids. However, none has produced uniformly satisfactory results. Combinations of more than one modality have also been employed to yield successful outcomes. We describe cryotherapy as a single modality to treat sevenyear-old, multiple earlobe keloids. Three cryotherapy sessions with two freezing-thawing cycles of 30-40 seconds’ freezing time and two minutes’ thawing time, undertaken one month apart, resulted in complete flatness of the keloids and no recurrence after 5 years. We also evaluate keloid-related and operational factors that determine the success of cryotherapy as a monotherapy for earlobe keloids.

Intracranial Atherosclerosis And The Earlobe Crease (Frank's Sign). A Population Study / Aterosclerosis Intracraneal Y Pliegue Auricular (Signo De Frank). Estudio Poblacional

ABSTRACT Background: The earlobe crease (ELC) has been linked to coronary artery disease and other vascular conditions, but there is no information on its association with intracranial atherosclerosis. Objective: This study aimed to assess the association between high calcium content in the carotid siphons (as a surrogate of intracranial atherosclerosis) and ELC in community-dwelling adults living in rural Ecuador. Methods: Atahualpa residents aged ≥40 years underwent head CT to estimate calcium content in the carotid siphons, and visual inspection of both earlobes to evaluate the presence of ELC. The association between both variables was assessed by logistic regression models, after adjusting for demographics and cardiovascular risk factors. Results: Of 651 enrolled individuals (mean age: 59.7±12.8 years; 54% women), 225 (35%) had ELC, and 143 (22%) had high calcium content in the carotid siphons. Univariate logistic regression showed a borderline (non-significant) association between high calcium content in the carotid siphons and ELC presence (OR: 1.44; 95% C.I.: 0.99 - 2.12; p=0.057), which disappeared when age (OR: 0.98; 95% C.I.: 0.65 - 1.48; p=0.923) and other covariables (OR: 0.97; 95% C.I.: 0.63 - 1.49; p=0.890) were added to the model. Conclusion: This population study shows no association between high calcium content in the carotid siphons and ELC presence.

RESUMEN Antecedentes: El pliegue auricular se ha relacionado con enfermedad coronaria y otras patologías vasculares, pero no hay información sobre su asociación con aterosclerosis intracraneal. Objetivo: Este estudio tuvo como objetivo evaluar la asociación entre el contenido de calcio en los sifones carotideos (como un sustituto de aterosclerosis intracraneal) y el pliegue auricular en adultos viven en zonas rurales de Ecuador. Métodos: Los residentes de Atahualpa de 40 años o más fueron sometidos a TC de cerebro para estimar el contenido de calcio en los sifones carotideos. Además, ambas orejas fueron examinadas para detectar la presencia de pliegues auriculares. La asociación entre ambas variables se evaluó mediante modelos de regresión logística, ajustados por factores demográficos y de riesgo cardiovascular. Resultados: De 651 individuos enrolados (edad media: 59,7±12,8 años, 54% mujeres), 225 (35%) tuvieron pliegues auriculares y 143 (22%) tuvieron alto contenido de calcio en los sifones carotideos. La regresión logística univariada mostró una asociación limítrofe (no significativa) entre el contenido de calcio en los sifones carotideos y la presencia de pliegue auricular (OR: 1.44, 95%IC: 0.99 - 2.12, p=0.057), que desapareció cuando la edad (OR: 0.98; 95% I.C.: 0,65 - 1,48; p=0,923) y otras covariables (OR: 0,97; 95% I.C.: 0,63 - 1,49; p=0,890) fueron agregadas al modelo estadístico. Conclusión: El presente estudio no mostró asociación entre el contenido de calcio en los sifones carotídeos y la presencia de pliegue auricular.

Study To Evaluate The Frequency Of Diagonal Earlobe Crease As A Marker Of Coronary Artery Disease And Its Risk Factors In Tertiary Hospital Of East India.

Background: In coronary artery disease (CAD), the DELC (diagonal ear lobe crease) has been proposed as a marker but association remains controversial. The aim of the present study was to evaluate the frequency of DELC in patients with CAD. Materials and Methods: One hundred fifty four patients with coronary artery angiography proven CAD from RIMS, Ranchi, Jharkhand, India were evaluated for the presence or absence of DELC. The DELC was said to be present if the patient had crease extending diagonally from the tragus across the lobule to the rear edge of the without discontinuity. Observation: DELC was seen in 82 patients out of 154, and the prevalence was 53.24%. Prevalence of Hypertension, diabetes and dyslipidemia were 38.3% ,33.8% and 24.0% respectively and hypertension, diabetes and dyslipidemia were insignificant(P=0.245, P=0.526, P=0.203 respectively).There were 43 smoker (27.9%) and DELC with smoking was significant with p value(0.021). Conclusion: The frequency of DELC in patients with CAD was high in our study. The data suggest that the DELC sign may be a useful marker for the presence of CAD in patients and may help in early segregating at risk patient of CAD

Association between diagonal earlobe crease and coronary artery disease / Шинэ санаа Шинэ нээлт

@#Association between diagonal earlobe crease (DELC), also known as Frank’s sign and CAD was first found by Sanders T. Frank in 1973. Since its first description, others have shown it to be associated with the presence, as well as the extent and severity of CAD, independent of traditional CAD risk factors, such as serum lipids, diabetes mellitus, and smoking status.DELC is also associated with higher risk of major adverse cardiac events in patients with known CAD.Recent studies have suggested that DELC may also be a marker of generalized atherosclerotic disease. This study evaluates the association between the presence of diagonal earlobe creases (DELC) and coronary artery disease (CAD). Four hundred people (246 men and 154 women, aged 28 to 92 years) were examined for the presence of DELC.400 people participated. In case group 200 people(142 men and 58 women, aged 30-87) who were getting treatment at State’s central 3rd hospital participated. In control group 200 people(104 men and 96 women, aged 28-92 who were getting treatment at State’s central 3rd hospital, National Traumatology Center included.We did statistic processing with MS Excel 2013, SPSS 20.0 DELC was present in 164 patients (82%) and absent in 36 patients (18%) of 200 participants documented with CAD (presence of > or = 50% coronary diameter stenosis at angiography). DELC was present in 42 people (21%) and absent in 158 people (79%) of 200 people documented without CAD. 82% of individuals with CAD had DELC. There was significant association between diagonal earlobe crease (DELC) and coronary artery disease (CAD), (p=0.039).

Frank’s sign – A dermatological link to coronary artery disease?

Frank’s sign, also known as diagonal earlobe crease (DELC), was observed to be an aural sign of coronary artery disease (CAD). Since then, there has been much interest in examining this unique and controversial association. This report describes a patient who has bilateral complete and deep diagonal ear lobe creases, presented with angina and diagnosed to have coronary artery disease on angiography. The characteristics of the sign and its association with atherosclerotic disease were discussed.

Correction of congenital cleft earlobe with front and back flaps

Congenital auricular deformities may be either deformational or malformational. Malformational anomalies present with a skin or cartilage shortage. Two cases with congenital cleft earlobe were presented. A new surgical technique using a two–layered repair with front and back flaps were introduced. She waited to begin wearing earrings until six months after the surgery to prevent possible scar contracture. The patients were followed up for a period ranging from 3 to 14 months. The earlobe volume deficiency was replaced, and acceptable scar maturation was obtained.

Keloidectomy with core fillet flap and intralesional verapamil injection for recurrent earlobe keloids.

Background: Earlobe keloids are usually recalcitrant to treatment and have a high rate of recurrence. Verapamil is a calcium channel antagonist that has been shown to inhibit the synthesis/secretion of extracellular matrix molecules and increase collagenase. Objectives: This prospective study was designed to evaluate the results of treatment of recurrent earlobe keloids using keloidectomy with core fillet flap and intralesional verapamil injection. Methods: Nineteen keloids in 16 patients were treated using this technique with intralesional verapamil injection given intraoperatively, then every 2 weeks for 3 months, with postoperative follow‑up for 18 months. Results: Fourteen patients completed the study. Ten patients (71.4%) showed response to treatment. Four (28.6%) cases showed recurrence, two (14.2%) at the wound bed and another two (14. 2%) at the incision line. Eighty percent of responders were highly satisfied with their treatment. Conclusion: Keloidectomy with core fillet flap and intralesional verapamil injection is a reliable and cost‑effective method in the treatment of recurrent earlobe keloids with a low rate of recurrence and high patient satisfaction.

A Case of Sebaceoma on the Right Earlobe / 대한피부과학회지

Sebaceoma, also known as sebaceous epithelioma, is a rare, benign, adnexal tumor with sebaceous differentiation. It usually appears as a yellowish papule, nodule, or plaque on the scalp and face, on which there are abundant sebaceous glands. Histologically, it is a well-circumscribed lesion composed of undifferentiated basaloid cells and mature sebaceous cells in relatively preserved lobulated architectures. A 31-year-old woman presented with a 1.3-cm ×1.1-cm nodule on the right earlobe. Mohs micrographic surgery was performed to completely remove it. Histopathological examination revealed that mature sebaceous cells with scalloped nuclei and focal cystic change were present in the lobule.

Intralesional Cryosurgery for the Treatment of Earlobe Keloid / 대한피부과학회지

Keloids are benign cutaneous lesions that result from excessive collagen synthesis and deposition. Earlobe keloids are commonly seen as a complication of earlobe piercing and infection. Many different treatment modalities are available; however, therapeutic results are often unsatisfactory. Cryosurgery either used as monotherapy or in combination has been used successfully. However, keloids may require multiple sessions to achieve significant improvement and have a high rate of recurrence. Compared to conventional cryosurgery, intralesional cryosurgery has advantages of proper freezing of the deep layer of the lesion and a less harmful effect on the superficial layers. Herein, we present three cases of earlobe keloid effectively treated with intralesional cryosurgery.

Pliegue diagonal del lóbulo auricular (de Frank) y su relación con enfermedad coronaria / Diagonal earlobe crease (Frank's sign) and its relationship with coronary artery disease (CAD)

La presencia de pliegue diagonal auricular debe alertar al médico para entender su asociación con la enfermedad cardíaca coronaria y la enfermedad isquémica del corazón, especialmente en aquellos pacientes asintomáticos o pacientes con factores de riesgo tradicionales y no tradicionales. Por lo tanto, esta anormalidad puede ser interpretada como un "marcador cutáneo" de la enfermedad cardíaca coronaria. Este signo también podría servir para identificar mejor a los grupos de alto riesgo cardiovascular y para comenzar con la implementación de las medidas de las estrategias de prevención. Hay otros signos clínicos, además del pliegue de la oreja, que pueden reflejar el envejecimiento arterial y aterosclerosis, independientemente del número, duración o alcance de los factores de riesgo cardiovascular tradicionales. El hallazgo de pliegue auricular no debe sustituir a una historia clínica completa, la aplicación de métodos detallados, exámenes de laboratorio y físicos utilizados con excelente rendimiento en el diagnóstico de la enfermedad coronaria en la actualidad.

A diagonal earlobe crease (ELC) should alert doctors to its association with coronary artery disease (CAD) (also known as ischemic heart disease or atherosclerotic heart disease), especially in asymptomatic patients or patients having non-traditional and traditional risk factors. Such abnormality may be interpreted as a skin marker for CAD and this sign may also be used for identifying groups at high cardiovascular risk and indicate when to begin prevention strategy measures. Other clinical signs (apart from ELC) may reflect arterial aging and atherosclerosis, regardless of traditional cardiovascular risk factors' number, duration and/or scope. A finding of ELC should not replace a full medical history being compiled, complemented by the excellent detailed methods and physical and laboratory tests used today for providing a reliable diagnosis regarding coronary disease.

Association Between Earlobe Crease and the Metabolic Syndrome in a Cross-sectional Study / 한국역학회지

OBJECTIVES: Several studies found a significant association between earlobe crease (ELC) and cardiovascular disease (CVD). Metabolic syndrome (MS) is a group of high-risk factors that are a collection of cardiovascular risk factors. Scant data are available about the relationship between ELC and MS. The purpose of the current study was to examine the correlation between ELC and MS. METHODS: A cross-sectional study was performed on 3,835 subjects (1,672 females, 43.6%) aged 20 to 79 years who visited a health promotion center. To increase the reliability of the diagnosis of MS, both the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and International Diabetes Federation (IDF) criteria were applied. Independent association between ELC and MS was assessed using multiple logistic regression analysis after adjusting for confounding variables. RESULTS: The frequency of ELC was 20.89% and the prevalence of MS was 11.03% (NCEP criteria) and 9.75% (IDF criteria). The prevalence of both ELC and MS significantly increased with age. The modified Framingham risk score was significantly higher in subjects with ELC than without. After adjusting for conventional risk factors for CVD, the risk of MS increased significantly in the presence of ELC. CONCLUSION: The current study showed that the odds ratio for MS increased in the presence of ELC in Korean adults. ELC is an auxiliary indicator of MS, although prognostic value might be limited. Further studies are warranted to elucidate the clinical significance of ELC.

A Comparative Study on Recurrence of Earlobe Keloids after Postoperative Adjuvant Therapy / 대한피부과학회지

BACKGROUND: Earlobe keloids are a cosmetically and symptomatically bothersome clinical problem with frequent recurrence despite various treatments including surgical excision and intralesional injection of corticosteroids. OBJECTIVE: The aim of this study was to compare the results and recurrence of earlobe keloids after various postexcisional adjuvant therapies and to identify the most effective postoperation adjuvant therapy. METHODS: We retrospectively evaluated 36 patients with earlobe keloids (n=71) who underwent core excision and a suprakeloidal flap using photographs. One group did not have adjuvant therapy, one group was treated with adjuvant triamcinolone intralesional injection (TRA/ILI), and another group was treated with postoperative irradiation. RESULTS: Among treated 71 keloids, 18 lesions (25.4%) recurred; 42.9% (12/28) of the operation-only group and 19.4% (6/31) of TRA/ILI group showed recurrence. The adjuvant radiation therapy group had no recurrence. The difference in recurrence rate was statistically significant. CONCLUSION: Postexcisional adjuvant therapy was more effective than excision monotherapy for keloid treatment, and radiation therapy had more sustained effects than that of TRA/ILI.

A One Stage Reconstruction of Defective Type Cleft Earlobe: Infra-auricular Transposition Flap

PURPOSE: Reconstruction of the cleft earlobe is challenging. Several procedures are available to reconstruct congenital earlobe deformities. However, for large defective type, surgical procedures and designs are complex and tend to leave a visible scar. We present a simple method of reconstruction for defective type congenital cleft earlobe using a one stage technique with infra-auricular transposition flap. This allows for easy and accurate size estimation and good aesthetic outcomes. METHODS: A 4-year-old male patient has congenital cleft earlobe and antihelical deformity. Otoplasty for antihelical deformity correction and one stage infra-auricular transposition flap for earlobe reconstruction were performed. The flap was designed from the inferoanterior margin of the earlobe. The size of the flap was determined based on the normal side, and the width and length of the flap was 1 cm and 3 cm in size, respectively. An incision was made at the midline of the defective lobule. Further, the elevated flap was inserted. The elevated flap and the incision margins of the lobule were sutured together. Then, the donor site was closed primarily. RESULTS: The volume and shape of the reconstructed earlobe were natural. There was no flap necrosis. The donor site had no morbidities and scar was not easily notable. CONCLUSION: Infra-auricular transposition flap can be designed easily and offer sufficient volume of earlobe. Furthermore, the scar is inconspicuous. In conclusion, infra-auricular transposition flap can be a good option for reconstructing a large defect type cleft earlobe.

Relationship Between Earlobe Crease and Brachial-ankle Pulse Wave Velocity in Non-hypertensive, Non-diabetic Adults in Korea / 한국역학회지

OBJECTIVES: Several studies have found a significant association between the presence of earlobe crease (ELC) and cardiovascular disease (CVD). Brachial-ankle Pulse Wave Velocity (baPWV) is a non-invasive and useful measure of arterial stiffness predicting cardiovascular events and mortality. However, few studies have reported the relationship between ELC and baPWV as a new measure of arterial stiffness. The purpose of this study was to determine whether ELC is related to baPWV in non-diabetic, non-hypertensive, and apparently healthy Korean adults. METHODS: A cross-sectional study was conducted on 573 non-hypertensive, non-diabetic Korean adults aged 20-80 yr. Subjects were stratified into three groups according to gender and menopausal status. baPWV was measured by an automatic waveform analyser. The association between ELC and baPWV was assessed by multiple linear regression analysis after adjusting for conventional cardiovascular disease risk factors including age, gender, blood pressure, lipid profile, and smoking status etc. RESULTS: The overall frequency of ELC was 19.02% and the subjects with ELC showed significantly higher mean baPWV (p<0.0001). Multiple linear regression of subjects revealed that the presence of ELC was independently associated with baPWV (male, p<0.0001; premenopausal female p=0.0162; postmenopausal female p=0.0208). CONCLUSION: ELC had a significant correlation with baPWV, independently controlling for other classical cardiovascular risk factors in adults aged 20 yr or older. ELC is an important surrogate marker of increased arterial stiffness as measured by baPWV in Korean adults.

Reconstruction of Defective Type Congenital Cleft Earlobe with S-shaped Flap

PURPOSE: Congenital cleft earlobe is relatively rare malformation and defective type congenital cleft earlobes are reconstructed with mainly local flap methods rather than primary closure or z-plasty. Various methods are introduced but many of these remain visible scars or require complex operative techniques. We designed a new and simple method of reconstruction for defective type cleft earlobe. METHODS: On the posterior surface of the auricle and mastoid area, S-shaped line was drawn continuously. One arc is for turnover hinge flap to make the anterolateral surface of the earlobe, and the other is for transposition flap to reconstruct the posterolateral surface. The donor site of the transposition flap was closed primarily. RESULTS: Four patients were operated by S-shaped flap design method. They were all female, and defective sides were right in two and left in another two. We obtained aesthetically satisfactory postoperative results with inconspicuous scars at the posterior side of the auricle. In one case, minor revision was performed because of insufficient blood supply of the hinge flap. CONCLUSION: We can reconstruct defective type cleft earlobe with new, simple S-shaped design for hinge flap and transposition flap.

Surgery and Perioperative Intralesional Corticosteroid Injection for Treating Earlobe Keloids: A Korean Experience

BACKGROUND: The aesthetic implications of ear keloids, which affect people of all races, are serious and the treatment of earlobe keloids is known to be difficult. The high rate of recurrence following excision alone has led to investigating various types of adjuvant therapy, including intralesional corticosteroid injection. OBJECTIVE: We evaluated the efficacy of excision combined with perioperative intralesional triamcinolone acetonide injection for treating earlobe keloids of Korean patients. METHODS: From 1997 to 2006, eighteen keloids on the earlobes of fifteen Korean patients were treated. The patient age ranged from 15 to 32 years (mean age: 24 years). All the patients were female and the keloids occurred after ear piercing. Preoperative intralesional triamcinolone acetonide (TA) injection was administered twice at a 1-month interval. Postoperative intralesional TA injections were given every 1 month for several months, depending on the patient's clinical progress. RESULTS: The follow-up period ranged from 4 to 42 months (mean: 18.5 months). After the surgery, TA intralesional injections were given 2 to 13 times (mean: 5.2 times). Of the treated keloids, eleven showed good results (61.1%) and three recurred (16.6%). No complications from the TA intralesional injection were observed. CONCLUSION: Among the various treatments for earlobe keloids, we suggest that excision with corticosteroid intralesional injection can be used as the first line therapy when considering its effect and economic advantage.

Surco diagonal en el lóbulo de la oreja: ¿signo de enfermedad arterial coronaria? / Diagonal earlobe crease, a sign of coronary artery disease?

El surco diagonal es un signo encontrado en el lóbulo de la oreja, que estaría relacionado con la enfermedad arterial coronaria. Nuestro objetivo fue estudiar la utilidad del signo. Se examinaron 104 pacientes (entre 30 y 80 años) clasificados por sexo y edad. Cuarenta y nueve tenían enfermedad arterial coronaria diagnosticada por coronariografía (obstrucción > del 70% en una de las grandes arterias) y/o gamagrafía de perfusión miocárdica con Talio 201 (defecto fijo). El grupo control estuvo compuesto por 55 pacientes (asintomáticos, con electrocardiograma normal). Los datos obtenidos fueron sensibilidad (61.2%), especificidad (78.2%), valor predictivo positivo de (71.4%) y valor predictivo negativo (69.3%.). Observamos una relación significativa entre la presencia de surco diagonal y enfermedad arterial coronaria. Consideramos que este signo podría resultar de utilidad en la práctica clínica, fundamentalmente para los pacientes entre 30 y 60 años.

The diagonal earlobe crease is a sign theorically related to coronary artery disease. The purpose of this study was to prove the usefulness of this sign. A total of 104 patients were examined (ages 30 to 80) grouped by age and sex. Forty nine of them were diagnosed of having coronary artery disease by coronary angiography (a 70% obstruction of one of the major arteries), and/or myocardial perfusion imaging with Thallium 201 (fixed defects). The control group included 55 patients (asymptomatic with normal electrocardiogram). Data here obtained included sensitivity (61.2%), specificity (78.2%), positive predictive value (71.4%) and negative predictive value (69.3%). We found a significant relation between the presence of the diagonal earlobe crease and coronary artery disease. We consider it a sign that could prove useful in clinical practice, mainly among patients aged between 30 and 60.

Reconstrucción parcial del pabellon auricular con colgajo retroauricular / Partial reconstruction with flap pinna retroauricular

El pabellon auricular por su situación anatómica se encuentra susceptible a una serie de lesiones traumáticas y/o patológicas, por lo que su reconstrucción es un verdadero desafío para el área quirúrgica encargada de mantener la simetría con el pabellon contralateral como su compleja estructura. Presentamos el caso clínico de un paciente con pérdida del borde helical, posterior a mordedura humana, reconstrucción del daño mediante colgajo retroauricular, una técnica versátil, sencilla que requiere siempre cumplir con todos los requisitos de orden técnico-quirúrgicos de tratamiento de movilización de colgajos.

The earlobe, due to its exposed situation, is susceptible to a variety of traumatic and/or pathologic lesions, therefore its reconstruction is a real challenge for surgery in order to maintain symmetry with the earlobe on the opposite side as its complex structure. Therefore we present the case of a patient with loss of the posterior helical border after a human bite. The damage was cured by retroauricular skin graft, a versatile, simple technique which requires always the fulfilment of all surgical technical requirements of treatment by movilization of skin grafts.

A Case of Huge Keloid in the Both Earlobes

Keloid is a benign proliferative disease of dermal collagen which extends beyond the original wound. Management of keloids is still controversial. Many different treatment modalities may be used for this purpose, however, no one method has been found completely successful. Therefore, we combined three techinques, which is surgical excision, lesional steroid injection and compression, to improve therapeutic outcomes for earlobe keloids. In the first session, surgical excision of the keloid was performed. It was followed with triamcinolone acetonide injetion to the surgical field on the postoperative one week, and then followed at two weekly interval for two months. Slight pressure was applied by earring for six months. The authors found that a combination of three techniques for treatment of ear lobe keloid is recommended even for the recurrent lesion.

Accessory Earlobe Malformation

A rare auricular malformation with an accessory earlobe is presented, and its method of correction is described. After review of literature, there has not been any previous report of such malformation. Relevant embryologic correlations are discussed. A 13-years-old girl is presented with a bilateral ear deformity that was present since birth. Two bulging masses below both ears and mild indentation of upper lobules were noticed. Bulging masses were removed and indented upper lobules were augmented by composite graft using these soft tissue. The pixie earlobes were also corrected using superiorly based flap of the lobe border. The external ear of the human develops from a fusion of six small hillocks at the region of the first and second branchial arches of the embryo. Although the case is limited to one, it is reasonable to presume that the mild depression of the upper lobule might have been caused by a deficiency of the divided hillock 1.