Keloid scarring

Keloids form following dermal scarring of tissue with abnormal wound healing. The scarring’s origin can be multifaceted, developing from any level of skin trauma or inflammation including surgery, burns, acne, insect bites and a multitude of other reasons.

How do keloids develop?

The etiology is not fully understood yet. Genetic and environmental factors are strongly implicated in its development in that incidents are higher in darker-skinned individuals of African, Asian, or Hispanic descent. Subsequent to an injury, fibroblasts produce exuberant and indefinite collagen and growth factors that cause aberrant wound healing.

How do keloids appear?

Keloids manifest as sturdy, enlarged raised scar that is pink or darker in color than the surrounding tissue. They appear hairless and shiny in relation to the tissue within proximity.  Keloids can arise anywhere on the body; however the upper chest, ears, and shoulders are more prone to them. Sometimes keloids can be misconstrued with hypertrophic scar, both have separate clinical and histochemical entities; hypertrophic scar is confined to the area of damaged skin, whereas keloids extend to nearby cells in the dermis.

Treatments for keloid scarring:

Various treatment modalities are available, but there aren’t any gold standard treatments that supersedes the others.

Options include:

• Steroid injection- considered as a first line of treatment, it may be used alone or in conjunction with other treatments.
• Cryotherapy- freezing early keloids to stunt their growth. This method is less recommended for darker people as it can lead to pigmentation.
• Surgical removal- often accompanied by another modality to remove the scar (high reoccurrence rate)

Keloids are generally harmless and painless and do not change into cancer; they are benign. Dark-skinned individuals and familial tendencies play an important role in the development and formation of keloids. The treatments address symptom alleviation, and since keloids have significant cosmetic repercussions, many of the treatments are directed towards cosmetic concerns.

Written by: Naif Alshaikh, Medical Student 

Resources:

dermnetnz.org
www.nhs.uk
Plast. Reconstr. Surg. 117: 286, 2006
https://www.ncbi.nlm.nih.gov/books/NBK507899