A 26‑year‑old female  presented with a swelling on her right ear lobe for 3 years. She gave a history of the ear-piercing when she was 3 years old, which was uneventful. She again underwent ear-piercing at the age of 23 years, 1 cm above the previous site, after which she developed swelling, which continued to grow until it reached the present size.

Examination revealed the swelling to be firm, nontender, dumbell‑shaped, 3 cm in diameter, engaging medial to the inferior part of the helix.

She was given a clinical diagnosis of keloid or an irritational fibroma, which was then surgically excised. The histopathological sections discovered hyperorthokeratinized stratified squamous epithelium and superficial dermis displayed fibroblastic cells arranged parallel to the epidermal surface with diffuse chronic inflammatory cells.

Mild to deep dermal sclerosis showing a large dense bundle of glassy collagen, was also seen, thus a final diagnosis of keloid was made.

Van Gieson’s staining revealed yellow-colored epidermis and thick collagen bundles stained red in the dermis.

Polarized light showed collagen bundles as reddish to orange birefringence indicating thick fibers.

Immunohistochemical markers were also evaluated and expression of α‑SMA (alpha smooth muscle actin) was seen in myofibroblasts, blood vessels and fine collagen fibers. Scattered diffuse staining of S‑100 was observed and expression of desmin was found to be negative. 

No recurrence was observed after 1 year.