Keloid

A keloid is a special case of a scar. Keloids form within the 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 usually at the site of injury, keloids can spontaneously occur. They can occur at the site of a piercing and have been found on earlobes, eyebrows, the chest and other sites of piercings. They can occur as a result of severe acne or chickenpox scarring. They can 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. They tend to reccur 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.

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.

Keloids are firm, rubbery lesions which are reddish or darkly colored. They may be shiny hard pink dome shaped lumps. There is a fifteen times higher frequency of occurence in darker races. Kelly

Intentional keloids

The African-Olmec of Mexico in pre-Columbian times used keloid scarification as a means of decoration. The Olmec (of South America) used other scarification as well. [1] In the modern era, women of the Nubia-Kush in the Sudan are intentionally scarified with fascial keloids as a means of decoration. [2] The Nuer and Nuba use lip plugs, keolid tatoos along the forehead, keloid tatoos along the chin and above the lip, and cornrows. [3]. As a part of ritual, the people of Papau 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. [4]

Treatments

• Surgery — Surgery requires great care and after care. Some 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 or another corticosteroid may reduce keloid size and irritation, but injections can be uncomfortable.

• Compression — Compression bandages applied to the site over several months, sometimes as long as six to twelve months may produce reduction in size. They work best as a preventive for new scars.

• Cryosurgery — Cryosurgery is an excellent treatment for keloids that 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. There is a slough of skin and keloid with re-epitelization. It does in effect create a local frostbite. It does cause a superficial peel of heavy skin.

• Radiation therapy — Electron beam radiation can be used but often not go deep enough to affect internal organs. Orthovoltage radiation is more penetrating and slightly more effective. There have not been any reports of this causing any form of cancer in many years of use, but it is very expensive Radiation treatments may reduce scar formation if they are used soon after a surgery, during the time 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 result than cold laser.

• Newer treatments — Using drugs which treat autoimmune illnesses or cancers has shown some promise. These include alpha-interferon, 5-fluorouracil and bleomycin. There is a need for further study and evaluation before general use.

Case study

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.