Clinical outcome and quality of life after a multimodal therapy approach to ear keloids

• Verfasst von: Walliczek-Dworschak, Ute [VerfasserIn]
• Verfasst von: Engel, Stephan [VerfasserIn]
• Verfasst von: Weiß, Christel [VerfasserIn]
• Verfasst von: Aderhold, Marc Christoph [VerfasserIn]
• Verfasst von: Lippert, Christiane [VerfasserIn]
• Verfasst von: Schell, Angela [VerfasserIn]
• Verfasst von: Hörmann, Karl [VerfasserIn]
• Verfasst von: Schultz, Johannes D. [VerfasserIn]
• Titel: Clinical outcome and quality of life after a multimodal therapy approach to ear keloids
• Verf.angabe: Ute Walliczek, MD; Stephan Engel, MD; Christel Weiss, Dipl Math; Christoph Aderhold, MD; Christiane Lippert, MD; Angela Wenzel, MD; Karl Hörmann, MD; Johannes David Schultz, MD
• E-Jahr: 2015
• Jahr: Sept/Oct 2015
• Umfang: 7 S.
• Teil: volume:17
• Teil: year:2015
• Teil: number:5
• Teil: pages:333-339
• Teil: extent:7
• Fussnoten: Gesehen am 23.03.2018
• Titel Quelle: Enthalten in: JAMA facial plastic surgery
• Ort Quelle: Chicago, Ill. : American Medical Association, 2013
• Jahr Quelle: 2015
• Band/Heft Quelle: 17(2015), 5, Seite 333-339
• ISSN Quelle: 2168-6092
• DOI: doi:10.1001/jamafacial.2015.0881
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1571394451

Abstract

Importance: 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. Design, Setting, and Participants: 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. Interventions: 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. Main Outcomes and Measures: 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 and Relevance: 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.