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    "titulo" => "Keloid formation following ear piercing through the transitional zone"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Keloid formation following piercing through the transitional zone in patient 1 &#40;A&#41; and patient 2 &#40;B&#41;&#46; There is no keloid formation at the earlobe piercing points in both patients&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ear piercing is one of the major risk factors for keloid formation&#46; The majority of piercing is performed through the soft tissue of the earlobe only &#40;zone 1&#41;&#46; In addition&#44; it may be performed through the ear cartilage &#40;zone 2&#41; or the transitional zone &#40;zone 3&#41; between the ear cartilage and earlobe&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The incidence of complications due to transcartilagenous piercing is approximately 35&#37; because of the avascular nature of auricular cartilage&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There are no studies regarding transitional zone keloids in the literature&#46; We hypothesized that ear piercing through the transitional zone should be assessed as if through the cartilage zone&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We herein present three cases of keloid formation after ear piercing through the transitional zone of the ear&#46; None of our patients had a personal or familial history of keloid or hypertrophic scar formation&#46; The diagnosis was confirmed by histopathological examination for all patients&#46; The clinical features of the patients are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Patient 1 had a total of four piercings&#44; two in the right earlobe&#44; one in the left earlobe&#44; and one in the right transitional zone&#46; Patient 2 had a total of five piercings&#44; two in the right earlobe&#44; two in the left earlobe&#44; and one in the right transitional zone&#46; All piercings were performed simultaneously in both patients&#46; However&#44; no keloid formation was observed at the earlobe piercing points&#44; in which transcartilagenous piercing did not exist &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Patient 3 had only one piercing in the right transitional zone &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; A combination of intralesional corticosteroid administered at 40&#8239;mg&#47;mL over intervals of 3&#8210;4 weeks for 16 weeks and cryosurgery were performed&#46; Early recurrence was not observed in any patients during the first year of follow-up&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Piercing jewelry material&#44; earring backs&#44; the type of piercing procedure&#44; and complications related to piercing at the time of the procedure may contribute to keloid formation&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> None of our patients had a complication related to piercing at the time of the procedure&#46; In our cases&#44; keloid formation was more likely to be associated with a cartilage injury&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Currently&#44; the upregulation of cartilage oligomeric matrix protein &#40;COMP&#41;&#44; a noncollagenous extracellular matrix glycoprotein&#44; has been shown in keloidal tissue&#44; suggesting that COMP facilitates keloid formation by accelerating collagen deposition&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In addition&#44; it has been reported that multiple hereditary exostoses&#44; which are characterized by the development of multiple benign osteocartilaginous masses&#44; were found to be a risk factor for keloid formation after surgical excision of osteochondromas representing another association of keloids and chondrocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It was reported that there was no difference regarding piercing-related complications between the earlobe and the cartilaginous part of the ear&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> This result may be attributed to earlobe piercing being performed more frequently than cartilage or transitional zone piercing&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Assessing ear piercings through the transitional zone as if through the cartilage zone may be more appropriate&#46; Transitional and cartilage zones of the ear may be avoided during ear piercing to prevent the development of keloid formation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author&#39;s contribution</span><p id="par0045" class="elsevierStylePara elsevierViewall">All authors &#40;Ozge Zorlu&#44; Serkan Yazici&#44; &#350;aduman Balaban Ad&#305;m&#41; have been actively involved in study conception and planning&#44; critical literature review&#44; data collection&#44; analysis and interpretation&#44; research orientation&#44; preparation and writing of the manuscript&#44; and review of the manuscript&#46; All authors read and approved the final version of the manuscript&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Letter - Clinical
Keloid formation following ear piercing through the transitional zone
Ozge Zorlua,
Corresponding author
zorluzg@gmail.com

Corresponding author.
, Serkan Yazicia, Şaduman Balaban Adımb
a Department of Dermatology and Venereology, Bursa Uludag University School of Medicine, Bursa, Turkey
b Department of Pathology, Bursa Uludag University School of Medicine, Bursa, Turkey
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    "titulo" => "Keloid formation following ear piercing through the transitional zone"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Keloid formation following piercing through the transitional zone in patient 1 &#40;A&#41; and patient 2 &#40;B&#41;&#46; There is no keloid formation at the earlobe piercing points in both patients&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ear piercing is one of the major risk factors for keloid formation&#46; The majority of piercing is performed through the soft tissue of the earlobe only &#40;zone 1&#41;&#46; In addition&#44; it may be performed through the ear cartilage &#40;zone 2&#41; or the transitional zone &#40;zone 3&#41; between the ear cartilage and earlobe&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The incidence of complications due to transcartilagenous piercing is approximately 35&#37; because of the avascular nature of auricular cartilage&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There are no studies regarding transitional zone keloids in the literature&#46; We hypothesized that ear piercing through the transitional zone should be assessed as if through the cartilage zone&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We herein present three cases of keloid formation after ear piercing through the transitional zone of the ear&#46; None of our patients had a personal or familial history of keloid or hypertrophic scar formation&#46; The diagnosis was confirmed by histopathological examination for all patients&#46; The clinical features of the patients are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Patient 1 had a total of four piercings&#44; two in the right earlobe&#44; one in the left earlobe&#44; and one in the right transitional zone&#46; Patient 2 had a total of five piercings&#44; two in the right earlobe&#44; two in the left earlobe&#44; and one in the right transitional zone&#46; All piercings were performed simultaneously in both patients&#46; However&#44; no keloid formation was observed at the earlobe piercing points&#44; in which transcartilagenous piercing did not exist &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Patient 3 had only one piercing in the right transitional zone &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; A combination of intralesional corticosteroid administered at 40&#8239;mg&#47;mL over intervals of 3&#8210;4 weeks for 16 weeks and cryosurgery were performed&#46; Early recurrence was not observed in any patients during the first year of follow-up&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Piercing jewelry material&#44; earring backs&#44; the type of piercing procedure&#44; and complications related to piercing at the time of the procedure may contribute to keloid formation&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> None of our patients had a complication related to piercing at the time of the procedure&#46; In our cases&#44; keloid formation was more likely to be associated with a cartilage injury&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Currently&#44; the upregulation of cartilage oligomeric matrix protein &#40;COMP&#41;&#44; a noncollagenous extracellular matrix glycoprotein&#44; has been shown in keloidal tissue&#44; suggesting that COMP facilitates keloid formation by accelerating collagen deposition&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In addition&#44; it has been reported that multiple hereditary exostoses&#44; which are characterized by the development of multiple benign osteocartilaginous masses&#44; were found to be a risk factor for keloid formation after surgical excision of osteochondromas representing another association of keloids and chondrocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It was reported that there was no difference regarding piercing-related complications between the earlobe and the cartilaginous part of the ear&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> This result may be attributed to earlobe piercing being performed more frequently than cartilage or transitional zone piercing&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Assessing ear piercings through the transitional zone as if through the cartilage zone may be more appropriate&#46; Transitional and cartilage zones of the ear may be avoided during ear piercing to prevent the development of keloid formation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author&#39;s contribution</span><p id="par0045" class="elsevierStylePara elsevierViewall">All authors &#40;Ozge Zorlu&#44; Serkan Yazici&#44; &#350;aduman Balaban Ad&#305;m&#41; have been actively involved in study conception and planning&#44; critical literature review&#44; data collection&#44; analysis and interpretation&#44; research orientation&#44; preparation and writing of the manuscript&#44; and review of the manuscript&#46; All authors read and approved the final version of the manuscript&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;1 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">R&#44; AP&#44; zone 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;1 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">R&#44; A&#44; zone 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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Article information
ISSN: 03650596
Original language: English
DOI:10.1016/j.abd.2021.08.016
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Prêmio Bernardo Gontijo
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Anais Brasileiros de Dermatologia
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Anais Brasileiros de Dermatologia
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