Keloids Disease

BASICS

DESCRIPTION

Abnormally large overgrowth of fibrous tissue (scar) occurring as a result of trauma or irritation that does not subside with time

System(s) affected: Skin/Exocrine
Genetics:
- 5–15 times more common in blacks and Asians than Caucasians. In all races, more darkly pigmented individuals are at higher risk.
- Both autosomal dominant and autosomal recessive familial inheritance have been reported.
Incidence/Prevalence in USA: Largely unknown, but does affect 4-16% of the black and Hispanic population
Predominant age: N/A
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Pain
Tenderness
Hyperesthesia
Pruritus
Firm, smooth, elevated scar with sharply demarcated borders
Initially may be pale or mildly erythematous
Older lesion hypo- or hyperpigmented
Scar extends beyond margins of the initial wound
Over period of years, keloids continue to grow and may develop claw-like projections

CAUSES

Wounds: traumatic, surgical, body piercing
Burn injury
Other injuries
- Insect bite
- Folliculitis barbae and nuchae
- Acne

RISK FACTORS

Family history of keloids
Dark skin pigment
Certain locations on the body, e.g., deltoids, chest, earlobes
Pregnancy
Adolescence

DIAGNOSIS

LABORATORY

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Histology shows whorl-like arrangements of hyalinized collagen bundles with pressure thinning of papillary dermis and minimal elastic tissue

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Biopsy, only if unable to differentiate from carcinoma, since a biopsy may increase the keloid's size. If possible, use a 2 mm punch biopsy to minimize trauma.

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

"Step care" is warranted, adding pressure and then radiation if steroid injections fail.

Intralesional corticosteroid injections: cause atrophy and are most successful therapy
Pressure bandages: must maintain 24 mm Hg, and should be worn for 6–12 months. Bandages should not be removed for more than 30 minutes/day. Pressure clips useful for earlobes.
Radiation: no advantage over other methods; use if other methods fail, and then use in conjunction with steroids and pressure
Topical agents: No evidence to support efficacy; e.g., retinoic acid, vitamin E, antineoplastic agents, silicone gel

SURGICAL MEASURES

Surgery – high recurrence rate (45–100%), therefore used only for debulking of large keloids or if a lesion is unresponsive to steroid injections alone
Laser surgery – no definitive evidence of efficacy

ACTIVITY

Full activity

DIET

No special diet

PATIENT EDUCATION

Stress possibility of recurrence despite appropriate treatment
May require many months of treatment with combined modalities

FOLLOW UP

PREVENTION/AVOIDANCE

Primary prevention: avoid elective surgery or body piercing in high-risk patients
Compressive pressure dressings may be useful in high-risk (e.g., burn) patients. Local steroid injection postoperatively in high-risk patients is also effective.

POSSIBLE COMPLICATIONS

Skin atrophy, ulceration, depigmentation, telangiectasias can occur as a result of local steroid injections

EXPECTED COURSE AND PROGNOSIS

Lesions gradually diminish with therapy over a 6-18 month period, leaving a flat, shiny scar

MISCELLANEOUS

ASSOCIATED CONDITIONS

None

AGE-RELATED FACTORS

Keloid formation more common during adolescence

Pediatric: None
Geriatric: None
Others: N/A

PREGNANCY

Keloid formation more likely during pregnancy

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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