Double Helix

We often see problems for which there may be no simple solution. Ear lobe keloids are encountered with regularity; but keloids of the helix and triangular fossae are unusual. Some of you may have a simple trick for patients like these:

Patient # 1.
Abstract: 25 yo woman with ear keloid.

HPI: This 25 yo Asian woman pierced the triangular fossa of her right ear 2 years ago and developed a keloid which is pruritic and whose appearance bothers her.

O/E:


Patient # 2
As I was getting case # 1 ready to publish on this site, a second patient presented for evaluation and treatment.
This is a 16 yo girl with a one year history of a keloid of the left triangular fossa. She had a professional piercing done two years ago. This lesion is painful.




This patient had an "Industrial Piercing" with a 14 guage stainless steel rod.

Comment: Earlobe keloids are commonly seen and reported. But I could find no helpful articles about helix and triangular fossa keloids. I suspect that these lesions are not rare, since I have seen two in a few weeks in a small New England town. Perhaps, these are harbingers of an epidemic! One of these young women pierced her own ear, and the other was a professional job.

Questions:
These can not be simply excised and then injected with TAC like the more common ear lobe keloid. Wound closure would be problematic.
How would you approach these women?
Any role for shave excision followed by imiquimod?
Do you think TAC alone will work? 20 mg per cc, 40 mg per cc?
Does anyone have experience with similar lesions?