PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1312-1314 (doi:10.1542/peds.2004-1085)
Relationship Between Age of Ear Piercing and Keloid Formation
* Section of Dermatology, Department of Medicine
Department of Biostatistics and Bioinformatics, Medical College of Georgia, Augusta, Georgia
 |
ABSTRACT |
|---|
 TOP ABSTRACT METHODSRESULTSDISCUSSIONREFERENCES |
|---|
Objective. Keloids occur commonly after trauma to the skin, with ear piercing being a well-known inciting event. We surveyed 32 patients with keloids resulting from ear piercing, to examine a potential relationship between age of piercing and keloid formation.
Methods. A total of 32 consecutive patients completed a survey about ear-piercing and keloid formation. Fisher's exact test was used for data analysis.
Results. Fifty percent (n = 16) of surveyed patients developed a keloid after their first piercing. Twenty surveyed patients developed keloids with subsequent piercings. Those who had piercings at 
11 years of age were more likely to develop keloids (80%) than were those who had piercings at <11 years of age (23.5%).
Conclusions. Keloids are more likely to develop when ears are pierced after age 11 than before age 11. This observation holds true for patients with a family history of keloids. Given the difficulty and cost of treating keloids, prevention remains the best approach. Patients with a family history of keloids should consider not having their ears pierced. If this is not an option, then piercing during early childhood, rather than later childhood, may be advisable. Primary care physicians and pediatricians should educate children and their parents about the risk of keloid formation.
Key Words: keloids • ear piercings • children
Keloids and hypertrophic scars represent unregulated proliferation of fibrous tissue after cutaneous injury. Unlike hypertrophic scars, keloids extend beyond the site of the original injury and invade peripheral tissue. Clinically, keloids are flesh-colored, firm, and occasionally painful or pruritic tumors (Fig 1). The pathogenesis of keloid formation is largely unknown,1,2 although a familial tendency is well documented.1,3–5 Keloids are also more prevalent in the black population.
|
|
METHODS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Thirty-two consecutive patients with keloids completed a survey about ear-piercing and keloid formation. The survey and study protocol were approved by the institutional review board. Age at first piercing was defined 2 different ways, ie, (1) <11 years versus
11 years and (2) <1 year, 1 to 10 years, 11 to 18 years, and 19 years. Age 11 was chosen as the cutoff age because it marks the beginning of adolescence, with the average age of menarche in the United States being 
12 years.6 Consideration was given to the fact that the age of menarche is several months younger among black girls than among white girls and the average age of menarche in the Third National Health and Nutrition Examination Survey (1988–1994) was 2.5 months less than that in previous survey cycles II and III (1963–1970).6 Therefore, we used the threshold of 11 years of age in the current study to allow for this trend of decreasing age at menarche.6 Because of the small sample size, Fisher's exact tests were used to examine differences in the proportions of keloid formation according to age at first piercing and family history of keloids. |
RESULTS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Table 1 gives descriptive statistics for all variables. Most subjects were female (n = 27, 84.4%) and black (n = 27, 84.4%); subjects had a mean age of 24.06 years (SD: 11.05 years). Fifty-six percent of subjects had a family history of keloids, with 33% identifying their mother as the family member with keloids.
|
Fifty percent of study participants (n = 16) developed a keloid after their first piercing. Twenty patients, including some who developed keloids after their first piercing, developed keloids after their second piercing. Those who had their first piercing at
11 years of age were more likely to have a keloid (80%) than were those who had their first piercing before age 11 (23.5%) (P = .0038). Additional division of age groups revealed that subjects who had their first piercing between 11 and 18 years of age (83.3%) or at 19 years of age (66.7%) were more likely to have a keloid than were those whose first piercing was in infancy (25.0%) or between the ages of 1 and 10 years (22.2%) (P = .0109).
Those with a family history of keloids were no more or less likely to have a keloid at their first piercing than were those without a family history of keloids (P = 1.0000). However, when the proportions with keloids were examined according to age at piercing and family history of keloids status, differences existed. Among those with no family history of keloids (n = 14), those whose first piercing was before age 11 developed a keloid 16.7% of the time (n = 1), whereas those whose first piercing was at 11 years of age developed a keloid 75% of the time (n = 6). This suggested difference was not significant (P = .1026). Among those with a family history of keloids (n = 18), those with a first piercing before age 11 developed a keloid 27.3% of the time (n = 3), whereas those whose first piercing was at 11 years of age developed a keloid 85.7% of the time (n = 6). This difference was statistically significant (P = .0498).
Of 4 patients with keloids from their first piercing who dared to have additional piercings, all developed keloids with second and subsequent piercings. Among those whose first piercing was performed before age 11 and did not result in a keloid, 92.3% (n = 12) had a keloid after their second piercing at 11 years of age.
|
DISCUSSION |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Patients are frequently questioned regarding scarring and/or tendencies toward keloid formation before surgical procedures. Ear piercing, however, is routinely performed at retail establishments, where the formation of keloids is unlikely to be addressed. The pathogenesis of keloid formation is largely unknown and is beyond the scope of this article. Recent studies have focused on several growth factors; however, conclusive studies have not yet been performed.2–4 Numerous treatment modalities exist, but none is consistently effective. Treatments include topical corticosteroid treatment, intralesional corticosteroid treatment, pressure earrings, laser surgery, and surgical excision. Postsurgical recurrence is common. In addition, recurrent keloids are typically larger than the original keloid.
The current study demonstrates that keloids are more likely to develop when ear piercing occurs after age 11, compared with <11 years of age. This observation of increased risk of keloid formation around the time of puberty holds true for the surveyed patients with a family history of keloids. Additional study with a larger sample would aid in delineating these associations.
Given the difficulty and cost of treating keloids, prevention is the optimal approach. Patients with a family history of keloids should consider not having ear piercings. If piercing is nonnegotiable, however, then our pilot data suggest that piercing during early childhood should be considered. Primary care physicians and specifically pediatricians are in an ideal position to educate the public regarding the timing of ear piercings and the risk of keloid formation.
There are several limitations of this pilot study. First, this study enrolled a small number of participants. To delineate more clearly the relationship between age at the time of piercing, family history of keloids, and keloid status, a larger study needs to be conducted and is currently underway. It should be noted that this was a retrospective study and patient recollection of data might not have been completely accurate. In addition, subsequent piercings are often closer to and/or involve auricular cartilage (potentially an additional risk factor for keloid formation), a factor that could not be examined in this study. Additional studies are needed to better define the epidemiologic features of keloid formation.
The issue of keloids should be addressed during well-child visits. Although keloids may be primarily of cosmetic concern, they certainly affect individuals' self-esteem. Given the difficulty of treating keloids, prevention is optimal. These observations suggest that parents from keloid-prone families should consider having their children's ears pierced in infancy or early childhood or perhaps not at all. Primary care physicians, specifically pediatricians, should share this information with all families and specifically keloid-prone families.
|
FOOTNOTES |
|---|
Accepted Sep 15, 2004.
Address correspondence to Loretta S. Davis, MD, Section of Dermatology, Department of Medicine, Medical College of Georgia, 1004 Chafee Ave, Augusta, GA 30912. E-mail: lodavis{at}mail.mcg.edu
No conflict of interest declared.
|
REFERENCES |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
1. Bayat A, Bock O, Mrowietz U, Ollier WE, Ferguson MW. Genetic susceptibility to keloid disease: transforming growth factor ß gene polymorphisms are not associated with keloid disease. Exp Dermatol. 2004;13 :120 –124[Medline]
2. Liu W, Wang DR, Cao YL. TGF-ß: a fibrotic factor in wound scarring and a potential target for anti-scarring gene therapy. Curr Gene Ther. 2004;4 :123 –136[Medline]
3. Bayat A, Bock O, Mrowietz U, Ollier WE, Ferguson MW. Genetic susceptibility to keloid disease and hypertrophic scarring: transforming growth factor ß1 common polymorphisms and plasma levels. Plast Reconstr Surg. 2003;111 :535 –543[CrossRef][Medline]
4. Bayat A, Bock O, Mrowietz U, Ollier WE, Ferguson MW. Genetic susceptibility to keloid disease and transforming growth factor ß2 polymorphisms. Br J Plast Surg. 2002;55 :283 –286[Medline]
5. Marneros AG, Norris JE, Olsen BR, Reichenberger E. Clinical genetics of familial keloids.
Arch Dermatol. 2001;137
:1429
–1434
6. Anderson SE, Dallal GE, Must A. Relative weight and race influence average age at menarche: results from two nationally representative surveys of U.S. girls studied 25 years apart.
Pediatrics. 2003;111
:844
–850
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  Minerva BMJ, May 14, 2005; 330(7500): 1158 - 1158. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
