Keloid
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Template:DiseaseDisorder infobox | }} A keloid scar is a special kind of scar. Keloids are firm, rubbery lesions, and may be reddish or dark in color, or they may be shiny, hard pink-dome shaped lumps. They can result from injury to the skin or may form spontaneously. They often grow, and although they are harmless, non-contagious and usually non-painful, they can be a cosmetic problem.
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Occurrence
Keloids expand in clawlike growths into normal skin. They have the annoying capability to hurt with a needle-like jabbing pain or to itch uncontrollably without warning. Although these are temporary sensations that come and go, they can be extremely vexing for the victim.
If the keloid becomes infected, it may ulcerate. The only treatment is then to remove the scar completely. Unfortunately, the probability that the resulting surgery scar will also become a keloid is high.
Keloids form within scar tissue. Wound collagen, used in wound repair, tends to overgrow the area, sometimes producing a lump many times the size of the original scar. Although they usually occur at the site of an injury, keloids can arise spontaneously. They can occur at the site of a piercing and have been found on the earlobes, eyebrows, chest and other sites of piercings. They can occur as a result of severe acne or chickenpox scarring. They may also be caused by infection at a wound site, repeated trauma to an area, excessive skin tension during wound closure or a foreign body in a wound. They do not go away on their own, and tend to recur after excision. They affect both sexes equally although the incidence in young female patients has been reported to be higher than in young males, probably reflecting the greater frequency of earlobe piercing among women. There is a fifteen times higher frequency of occurrence in people of color. Black skin is most likely to develop keloids.
History in medicine
Keloids were described by Egyptian surgeons about 1700 BCE. Baron Jean Louis Alibert (1768-1837) identified the keloid as an entity in 1806. He called them cancroide. Later he changed the name to cheloide to avoid the connotation of cancer. The word is derived from the Greek chele, meaning crab's claw, and the suffix -oid, meaning like. His clinic at the Hospital St.Louis was for many years the world’s centre for dermatology.
Intentional keloids
The Olmec of Mexico in pre-Columbian times used keloid scarification as a means of decoration. In the modern era, women of the Nubia-Kush in the Sudan are intentionally scarified with facial keloids as a means of decoration. The Nuer and Nuba use lip plugs, keloid tattoos along the forehead, keloid tattoos along the chin and above the lip, and cornrows. As a part of ritual, the people of Papua New Guinea, cut their skin and insert clay or ash into the wounds so as to develop permanent bumps (known as keloids or weals). This painful ritual makes them well respected members of their tribe who are honored for their courage and endurance.
Locations of keloids
Keloids commonly occur on the shoulders, chest, arms and upper back even when there has been no apparent injury. These are usually the result of pimples, insect bites, scratching, or any other skin trauma.
Keloids can appear almost anywhere, such as within surgical scars post-operative, on ear lobes after piercing and behind the ears after octoplasty.
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Incidence
People of African or Asian descent are more likely to get keloids than people with lighter skin. (In this respect, keloids are exactly the opposite of most skin cancers which tend to occur in light-skinned people and spare people of color.)
Treatments
- Surgery — Surgery requires great care during and after the operation. Keloids that return after being removed may be larger than the original. There is a 45 percent recurrence of keloids surgically removed. However, keloids are less likely to return if surgical removal is combined with other treatments. Surgical or laser excision may be followed by intralesional injection with a corticosteroid to try to prevent recurrence. Plastic closure of the skin including such techniques as v-plasty or w-plasty to reduce skin tension are known to reduce recurrence of keloids following excision.
- Dressings — Moist wound coverings made of silicone gel or silastic sheets have been shown in studies to reduce keloid prominence over time. This treatment is safe and painless.
- Steroid injections — Steroid injections are best used as the scar begins to thicken or if the person was a known keloid former. Series of injections with triamcinolone acetonide, kenalog or another corticosteroid may reduce keloid size and irritation, but injections are often uncomfortable, and in larger and/or harder scars can be difficult and are performed with a local anasthetic for people over 16, and full anasthetic for people under. The treatment area can become very painful as the anasthetic wears off.
- Compression — Compression bandages applied to the site over several months, sometimes for as long as six to twelve months, may lead to a reduction in the size of the keloid. This treatment is best at preventing for new scars.
- Cryosurgery — Cryosurgery is an excellent treatment for keloids which are small and occur on lightly pigmented skin. It is often combined with monthly cortisone injections. The use of cryotherapy is limited since it causes skin blanching. It freezes the skin and causes sludging of the circulation beneath, effectively creating an area of localized frostbite. There is a slough of skin and keloid with re-epitelization. This also causes a superficial peel of heavy skin.
- Radiation therapy — Electron beam radiation can be used at levels which are do not penetrate the body deeply enough to affect internal organs. Orthovoltage radiation is more penetrating and slightly more effective. Although there have not been any reports of this causing any form of cancer after many years of use, it is very expensive. Radiation treatments may reduce scar formation if they are used soon after a surgery, while a surgical wound is healing.
- Laser therapy — This is an alternative to conventional surgery for keloid removal. Lasers may give a good superficial peel but often do not reduce the bulk of the keloid. The use of dye-tuned lasers has not shown any better results than cold lasers.
- Newer treatments — Drugs which are used to treat autoimmune illnesses or cancer have shown some promise. These include alpha-interferon, 5-fluorouracil and bleomycin. However, there is a need for further study and evaluation of this treatment technique.
Case presentation
This is a young male with bilateral keloid formation on the plantar surfaces of both feet. He has never been treated for this condition. There are other much smaller keloids located at small insults on the glaborous skin.
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