Summary

Severe earlobe scarring after piercing can result from overlapping allergic, mechanical, infectious and psychocutaneous factors, creating diagnostic challenges in differentiating hypertrophic scars from keloids. We present the case of a 35-year-old woman with bilateral nodular, fibrotic and indurated earlobe lesions. The lesions had progressively enlarged over 21 years after improper ear piercing performed under non-sterile conditions and were accompanied by recurrent eczema and infection.
Patch testing confirmed nickel allergy, while histopathology showed hypertrophic scarring with chronic inflammation. Concurrent self-induced ulcerations, clinically compatible with dermatitis artefacta, suggested a psychocutaneous component that may also have perpetuated the earlobe scarring. Given the chronicity of the lesions, persistent symptoms and psychological context, surgical management was considered appropriate. The affected tissue was excised, and the earlobes were reconstructed using preauricular and retroauricular rotational flaps. Postoperative healing was uneventful. At 6 months, the earlobe contours were restored with no evidence of recurrence. This case underscores the importance of integrating allergy testing, histopathology and psychological assessment in the evaluation of post-piercing earlobe lesions. Recognition of ongoing self-induced trauma before surgery can guide management and reconstructive planning.