Relationship between age of ear piercing and keloid formation

Objective. Keloids occur commonly after trauma to the skin, with ear piercing being a wellknown 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.