I read with great interest the article by Bran et al titled “Auricular Keloids: Combined Therapy With a New Pressure Device.”1 The authors introduce the novel adjuvant pressure therapy for ear keloids using a newly designed, custom-fitted pressure device combined with surgical excision and subsequent intralesional corticosteroid injection. They are to be commended for their efforts.
Keloids are often resistant to treatment and have high recurrence rates, and much of the history of postoperative adjuvant therapies has centered on prevention of keloid recurrences.2 Surgical excision followed by postoperative pressure therapy provides reasonably positive results in the reviewed literature.3 The proposed main mechanism of pressure therapy include hypoxia leading to fibroblast degeneration and collagen degradation. My institution previously reported the use of our novel adjuvant pressure therapy using magnets after surgical excision for treatment of 1436 ear keloids of 883 patients, with a significantly lower rate of recurrences (94 of 883 patients).3 The applied pressure was 35 mm Hg, which was estimated using a digital manometer. Characteristics of magnet that we have used are as follows: density, 7.4 g/cm3; diameter, 10 mm; and thickness, 2 mm. Patients were instructed to use the magnets for 12 hours per day (broken into 2 hours of magnet application followed by a half hour of relief). The magnets should be applied only when the patient's compliance is assured. Otherwise, despite its rarity, tissue necrosis may occur owing to continuous application of magnets without relief.