In children with a family history of keloid formation, ear piercing at age 11 years or older is more likely to result in keloid, according to the results of a study published in the May issue of Pediatrics. The investigators recommend against ear piercing in children who form keloids, but they otherwise recommend piercing before age 11 years.

"Keloids occur commonly after trauma to the skin, with ear piercing being a well-known inciting event," write Joshua E. Lane, MD, from the Medical College of Georgia in Augusta, and colleagues. "The pathogenesis of keloid formation is largely unknown, although a familial tendency is well documented."

In this study, 32 consecutive patients completed a survey about ear piercing and keloid formation. The investigators analyzed the data with Fisher's exact test.

Of the 32 patients, 16 (50%) developed a keloid after their first piercing, and 20 patients developed keloids with subsequent piercings. Keloid formation was more likely in patients who had piercings at age 11 years or older (80%) than in those who had piercings when younger than 11 years (23.5%). This observation held true for those patients with a family history of keloids.

"Given the difficulty and cost of treating keloids, prevention remains the best approach," the authors write. "Primary care physicians and pediatricians should educate children and their parents about the risk of keloid formation."

However, the authors note that ear piercing is typically performed at retail establishments, where keloid formation is unlikely to be addressed. None of the numerous treatment modalities currently available is consistently effective, including topical or intralesional corticosteroids, pressure earrings, laser surgery, and surgical excision. Postsurgical recurrence is common, and recurrent keloids are typically larger than the original keloid.

Study limitations include small sample size, retrospective design, and subsequent piercings often closer to or involving auricular cartilage, which may be an additional risk factor for keloid formation.

"Patients with a family history of keloids should consider not having their ears pierced," the authors conclude. "If this is not an option, then piercing during early childhood, rather than later childhood, may be advisable."