Keloids

Keloids occur worldwide in all skin types, and are considered a benign growth. The more darkly pigmented the skin, the higher the risk is for keloid formation. Keloids are often precipitated by trauma, including acne, piercings and burns. Men and women are equally affected.

After a wound has occurred to the skin, both skin cells and connective tissue cells (fibroblasts) begin multiplying to repair the damage. A scar is made up of ‘connective tissue’, fibers deposited in the skin by the fibroblasts to hold the wound closed. With keloids, the fibroblasts continue to multiply even after the wound is filled in. Thus keloids project above the surface of the skin and form large mounds of scar tissue.

In other words, keloids form when the body heals in an abnormal fashion. In people who are genetically predisposed to form keloids, the healing process goes too far creating scars which are much larger than needed to repair the original injury to the skin. Keloids have more cells, more vessels, and connective tissue compared to normal skin and normal scar.

Presentation:
Keloids appear as raised, initially pink-to-purple lesions that are often painful, itchy, or both. The surface is smooth and feels firm upon palpation and has a consistency of rubber. The lesions may be disfiguring, inhibiting normal ranges of motion of adjacent tissue. They may appear anywhere, but are frequently located on the upper back, chest, earlobes, and shoulders, or any area of high tension. Symptoms include increased pigmentation of the skin, redness, itchiness, increased sensation and occasionally pain.

Treatment:
Keloids may be often be prevented by using a pressure dressing or silicone gel sheets over the injury site. This treatment is used after healing of the wound or injury, usually within a month.

Intralesional corticosteroid injections are the most commonly used therapy for keloids and should be done once every month. After several injections with cortisone, the keloid usually becomes less noticeable and flattens in three to six month’s time. Surgery is inadvisable for most keloids, where the eventual recurrence rate is reported to be in excess of 80%. It is possible to reduce the height of a keloidal scar with surgery, but the width of the lesion remains, and the best outcome would be a flat scar. Intralesional corticosteroids or a drug called alpha-interferon may be combined with surgical excision. Radiation has also been combined with surgery to prevent recurrence of keloids following excision. Cryosurgery is another modality reserved for smaller keloids and lighter pigmented skin types.

References:
James W.D., Berger T.G., Elston D.M. Andrews’ Diseases of the Skin. 10th ed. Philadelphia: Elsevier Inc, 2006, pp.602-603.

External links: www.dermtext.com

Lela Lankerani, D.O.
Department of Dermatology
Philadelphia College of Osteopathic Medicine/Frankford Hospital
Philadelphia, Pennsylvannia.

Stephen M. Purcell, D.O., F.A.O.C.D.
Professor and Chairman of the Department of Dermatology
Philadelphia College of Osteopathic Medicine
Philadelphia, Pennsylvannia
www.adaltd.com