Keloids

 
         Keloid

Keloids are excessive scar tissue overgrowths at the sites of healed skin injury that extend beyond the original scar margins. They can be described as scars that do not know when to stop growing. Initial signs of keloid formation may be observed a few weeks following the injury. These heavy scars are also referred to as cheloids or keloid scars, and sometimes are mistakenly called hypertrophic scars. Keloids are tough, shiny or rubbery nodules that rise above the rest of the skin surface and can vary in color form pink to red to brown. Upon tanning, these scars may become darker than the rest of the skin and remain highly pigmented. Keloids are mostly found on earlobes, upper back, chest, and shoulders. The scars grow in a claw-like manner and tend to enlarge progressively. Some keloids flatten and become less noticeable over time but others may continue to grow indefinitely. They can be accompanied by sharp pain, severe itchiness, tenderness and increased sensitivity depending on the patient. Besides cosmetic and physical disfigurement, keloids cause discomfort and may lead to limited mobility when located over a joint.

Common Skin Keloid Symptoms

1. Keloids are a raised pink, red or brown nodules that develop at the site of injury
2. Keloid formed scar tissue projects above the surface of the skin
3. Keloids may grow beyond the original wound area
4. Keloid scars may be itchy and painful
5. Keloids may ulcerate if they get infected

Sometimes keloids are mistaken for hypertrophic scars. After skin heals, usually a flat scar is left at the site of an injury. In some cases, the scar tissue becomes thickened, or hypertrophic. Hypertrophic scars do not get as big as keloids and are limited to the area of the wound. They may fade over time.

What causes keloids?

No one knows why keloids form. Although most persons never form keloids, others develop them after minor injuries or even after insect bites or after acne bumps resolve. Keloids may form on any part of the body, although the ears, upper chest, upper back, and shoulders are especially prone to keloid formation. Persons with darker skin form keloids more easily than those with lighter skin, although anyone can form a keloid. Keloids never turn into skin cancer.

Keloids, on the other hand, are less common and may start developing some time after the injury. Ability of keloids to extend beyond the wound area and grow into the surrounding areas that were not injured before distinguishes keloids from hypertrophic scars.

Treatment

Keloids often do not need treatment. They may be reduced in size by:

Corticosteroid injections

External pressure

Freezing (cryotherapy)

Laser treatments

Radiation

The mainstay of treatment is intralesional triamcinolone acetonide. Corticosteroids are thought to downregulate collagen gene expression and produce dermal thinning in the area of treatment. Intralesional triamcinolone acetonide is effective as monotherapy when given at doses of 10–40 mg/ml every 2–4 weeks. Skin atrophy, hypopigmentation and telangectasias are potential adverse effects of intralesional corticosteroids. Its use is often combined with other modalities

Surgical excision is a treatment consideration for earlobe keloids or large bulky keloids that have failed medical therapy.