Large earring keloid of the right earlobe

The Piercing Keloid: Earlobe Keloids And Cartilage Keloids

Tattoos & Piercings

Ear piercings seem simple enough, and the vast majority heal smoothly. But, sometimes things go wrong and a dreaded piercing keloid develops. If you have an earlobe keloid or cartilage keloid or want to know about your risks of getting one, read on.

The Piercing Keloid

A dreaded type of ear piercing bump is the ear piercing keloid. Earrings are meant to be a stylish ornament and a cosmetic enhancement. An earlobe keloid or cartilage keloid, however, can form in a small fraction of ear piercings. For individuals unfortunate enough to form a keloid, earrings become a secondary consideration to this large tumor-like overgrowth of scar tissue.

What Is A Piercing Keloid?

Keloids can be understood as an overgrowth of scar tissue. Even normal piercing heal with some scarring, but it is so minimal that it is not perceptible. With piercing keloids, as with all keloids, the body seems to get stuck in the phase of wound healing in which collagen and other substances that makeup scar tissue are deposited at the site of the wound. The amount of scar tissue created is extremely excessive creating a tumor-like growth that is not only disfiguring but can also be painful and itchy. Keloids can have a devastating effect on the look of the ear and the psyche of individuals unfortunate enough to form one. Making the situation worse is that keloids can be very difficult to prevent or treat effectively.


Who’s At Risk For A Piercing Keloid?

Why keloids form in some people and not others is not fully understood. Some of the many known risk factors include:

  • dark skin tone
  • family history of keloids
  • Black or Asian ethnicity
  • repeatedly removing and reinserting earrings after piercing
  • earring infection

When Do Ear Keloids Show Up?

Ear lobe keloids and cartilage keloids can show up as early as one month after piercing. Most cases take around 3 or 4 months before the first signs of a keloid-type ear piercing bump are evident. Less commonly, they only begin to arise quite late, even up to a year or more after piercing. Late keloid development may be a result of trauma occurring to the ear piercing area such as by the earring catching on clothing. Once a keloid shows up, it can continue to grow for up to 2 years or more before stopping.

Small early earlobe keloid
Early stages of earlobe keloid development

Piercing Keloid Prevention

Anything at all that disturbs the healing can increase the overall risk of an ear piercing keloid. It’s notoriously challenging to prevent an earlobe keloid or cartilage keloid, but here are some widely accepted suggestions:

  • avoid infection:
    • only get piercings by reputable piercers and at reputable locations
    • never do “home piercings”
    • ask about the store’s protocols: are instruments and earrings sterile?
    • always wash hands with soap and water or use hand sanitizer before touching your ear
    • don’t fiddle with your earrings; this can delay healing and introduce germs
  • avoid unnecessary removal and re-insertion of your earrings, especially early after piercing
  • reconsider ear piercing if:
    • you have a previous ear piercing keloid
    • you have a keloid on other body areas
    • a close relative has an earlobe keloid or cartilage keloid


Ear Keloid Removal And Treatment

There are a number of methods used for ear keloid removal. Regardless of the technique used, recurrence of the keloid is common. Keloids are very challenging to remove and to prevent because, in many, if not most cases, they are more a result of a person’s natural healing tendencies than anything in particular that went wrong with the procedure or after-care. Keloids are part of a person’s “healing DNA” and circumventing this has proved elusive to medical experts. There is no universally accepted protocol for treating and then preventing keloids but a general guideline is shown here:

A decision tree showing a protocol for keloid treatment and prevention

Piercing Keloid Removal: The Surgical Process

Surgery is a mainstay of keloid removal because it allows for complete removal of the earlobe or cartilage keloid. Attention can then be focused on prevention. A typical ear keloid removal surgery will follow these steps:

  • disinfection of the skin using an antiseptic solution
  • injection of the earlobe keloid or cartilage keloid with a local anesthetic (similar to dental “freezing”)
  • excision of the keloid with possible injection of the wound area with cortisone
  • stitching of the incision
  • clean up and bandaging
  • discharge home

Very extensive keloids may require a general anesthetic because local anesthesia by injection becomes impractical. Most small to moderate-sized piercing keloid surgeries will be followed up by sequential cortisone injections every 6 weeks or so for about 3-4 sessions. Massive keloids may need post-surgical radiation therapy.

Here’s an excellent video produced by Beverly Hills plastic surgeon, Dr. Johnson C. Lee demonstrating a typical keloid removal surgery (Warning: Graphic Medical Content):

Pressure Earrings, Keloid Earrings

Pressure earrings are also known as keloid earrings, keloid pressure earrings, and compression earrings. They are clip-on devices that have been shown to help prevent keloids after removal by surgery, cryotherapy, or other methods. Pressure earrings must be worn for at least 12 hours per day for 6-12 months to be effective so they do require commitment. These products are commercially available through vendors like Amazon and Etsy and do not require a prescription.

Ear Keloid Removal At Home

Never attempt any sort of ear keloid removal at home such as by tying them off or using an elastic band. This is a terrible idea. Experienced dermatologists and plastic surgeons understand that keloid treatment very frequently fails even with optimal procedures. Moreover, keloids can even return bigger and worse after treatment attempts including well-accepted medical and surgical protocols. Attempting ear keloid removal at home in any way whatsoever will undoubtedly put you at risk for complications that can dramatically worsen your piercing keloid.


Ear Keloid Removal Cost

Removal of an earlobe keloid or cartilage keloid might be covered by insurance if it is deemed to be a medical problem more than a cosmetic one. Larger keloids causing symptoms such as severe itchiness and pain are more likely to be covered. Without coverage, ear keloid removal costs can be expensive because most protocols involve multiple treatment modalities. Also, recurrence happens in up to 50% of cases or more meaning ongoing treatments and additional expenses. Fees will vary depending on a number of factors including geographic location, doctor experience, and reputation, size of the keloid, and treatment methods required. Always make sure to consult with board-certified physicians. A very rough breakdown of fees is:

• smaller keloids
• large keloids
• massive keloids

• $250 – $750
• $750 – $3000
• $3000 – $10,000
• prices can vary widely depending on: geographic location, surgeon-demand, size of keloid, and type of anesthesia (local vs. general)
steroid injections• $75 – $250 per sessionmultiple sessions often required
cryotherapy• $200 – $300 per sessionmultiple sessions often required
radiation• up to $10,000

Beware Of Other Ear Piercing Bumps:

Other ear piercing bumps are related to infection, allergic reactions, and tissue overgrowth (granuloma). It is important to recognize these problems and address them early. Not doing so can lead to delayed healing and increase the chances of an earlobe keloid or cartilage keloid developing.

Earring Infection

Ear piercings seem relatively trivial but are actually minor surgical procedures. As such, they are subject to complications including infection. The fact that piercings also involve leaving a foreign object, the earring, into the newly penetrated skin, adds an extra risk factor. Any object placed into the body, from knee replacement parts to pacemakers, to earrings is a risk factor for infection. This concept is well known to doctors and piercing professionals. With ear piercing infection, bumps may be caused by simple swelling. In more advanced cases, an ear piercing infection bump represents pus or abscess developing under the skin. Other than developing a tender bump, you likely have an earring infection if you’re experiencing some or all of:

Ear piercing infection with red swollen ear lobe
Ear Piercing infection

Signs And Symptoms Of Earring Infections

  • increasing pain
  • increasing redness
    • redness may represent an allergy to the earring metal or cleansing solutions as opposed to infection, especially if it is also itchy
  • increasing swelling
  • warmth
  • drainage, oozing or crusting around the piercing
  • small blisters on the skin that leak yellow fluid
  • fever, chills, flu-like symptoms

How To Deal With Mild/Early Earring Infections

  • clean the back and front of the piercing 2 to 3 times per day with regular soap and water
  • do not use antibiotic ointments or rubbing alcohol
  • dry the area gently
  • don’t remove the earring at this point

Seek Medical Attention If

  • you develop fever, chills, or other generalized symptoms
  • the situation is not improving after 24 to 48 hours
  • it’s a cartilage (upper ear, mid-ear, tragus) earring infection; these can get worse quickly

You’r Doctor May Suggest

  • oral antibiotics
  • antibiotic creams
  • removal of the piercing
  • drainage of the area if an abscess is suspected

Preventing Earring Infections

  • only get piercings by reputable piercers and at reputable locations
  • never do “home piercings”
  • ask about the store’s protocols: are instruments and earrings sterile?
  • always wash hands with soap and water or use hand sanitizer before touching your ears
  • don’t fiddle with your earrings; this can delay healing and introduce germs

Allergic Reaction Ear Piercing Bumps:

Aside from an ear piercing infection, bumps may also be caused by swelling associated with an allergic reaction. Common causes of allergic reaction are the metal of the earring, chemicals in cleaning solutions, and antibiotic ointments you may be using. Switching to plain soap and water and discontinuation of washing solutions provided and antibiotic ointments can help resolve an allergic reaction. If the redness and itchiness persist, you may need to see your doctor who might prescribe an anti-allergy ointment such as cortisone. If nothing seems to be working, it is possible that the earring itself is the culprit and it may need to be removed.

It’s likely allergy if

  • the ear piercing is red, but not warm or very tender
  • the area is quite itchy

Granuloma Ear Piercing Bumps

Granulomas are composed of granulation tissue (“proud flesh”) and bleed quite easily. Sometimes bleeding may be difficult to stop. They form as a result of the earring repeatedly disrupting the ear-piercing healing process. If you think you have one, see your doctor sooner than later who will likely suggest removal of the granuloma under local anesthesia by shaving, freezing, or electrosurgery. If the nodule is large or recurs after removal, you will likely need to remove the earring and attempt a re-piercing later.

It’s likely a granuloma if

  • the ear piercing bump is red and fleshy looking and bleeds easily
  • there is not significant redness, or tenderness around the area
Fleshy red bump on earlobe called a granuloma
A granuloma is a common type of ear piercing bump

Don’t Assume Anything!

It’s important to remember that other sorts of growths can occur on the ear causing what appears to be an ear piercing bump. Some of these are totally unrelated to the ear piercing but occur around the piercing coincidentally. Benign cysts, moles, and even skin cancer growths can arise in this manner. Make sure to show any persistent bump on your ear to your doctor even if it is not bothersome.


A piercing keloid is a devastating outcome of a procedure that was intended to enhance individual style and aesthetics. Ear keloids pose a huge cosmetic challenge to people that form them and can be difficult to hide from public view. They can also be quite painful and itchy. Prevention and treatment protocols vary amongst medical specialists and recurrence remains the biggest challenge. Why they form and who will get an earlobe keloid or cartilage keloid is difficult to predict because of the many complex variables that contribute to an individual person’s overall risk.

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