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Keloid

Keloid

A keloid is an itchy, hard, raised, lump on the skin. It is the result of an overproduction of scar tissue. Keloids occur at the site of a skin injury. The injury can be a result from severe acne, a burn, an operation, a vaccination or a minor scratch.

 

Keloids are harmless. Sometimes they stop growing or disappear without treatment.

 

Keloid is also called keloid skin and hypertrophic scarring. They occur on darker skin much more often than on lighter skin.

 

Keloids can be considered to be "scars that don't know when to stop". A keloid, sometimes referred to as a keloid scar, is a tough heaped-up scar that rises quite abruptly above the rest of the skin. 

 

It usually has a smooth top and a pink or purple color. Keloids are irregularly shaped and tend to enlarge progressively. Unlike scars, keloids do not subside over time

Symptoms

Keloids are raised and look shiny and dome-shaped, ranging in color from pink to red. Some keloids become quite large and unsightly.

 

Aside from causing potential cosmetic problems, these exuberant scars tend to be itchy,  tender, or even painful to the touch.

 

The list of signs and symptoms mentioned in various sources for Keloid includes the 3 symptoms listed below:

 

  • Dome shaped scar which extends beyond the injury.
  • Red or dark in colour.
  • Local irritation or pain.

Causes

Doctors do not understand exactly why keloids form in certain people or situations and not in others. Changes in the cellular signals that control growth and proliferation may be related to the process of keloid formation, but these changes have not yet been characterized scientifically.

 

Keloids are equally common in women and men, although at least in times past more women developed them because of a greater degree of earlobe and body piercing among women. Keloids are less common in children and the elderly.

 

Although people with darker skin are more likely to develop them, keloids can occur in people of all skin types. In some cases, the tendency to form keloids seems to run in families.

Treatment

The best way to deal with a keloid is not to get one. A person who has had a keloid should not undergo elective skin surgeries or procedures such as piercing. When it comes to keloids, prevention is crucial, because current treatments are often not completely successful and may not work at all.

 

The best treatment is prevention in patients with a known predisposition. This includes preventing unnecessary trauma or surgery (including ear piercing, elective mole removal), whenever possible. Any skin problems in predisposed individuals (e.g., acne, infections) should be treated as early as possible to minimize areas of inflammation.

 

lntra-lesional corticosteroids — Intra-lesional corticosteroids are first-line therapy for most keloids. A systematic review found that up to 70 percent of patients respond to intra-lesional corticosteroid injection with flattening of keloids, although the recurrence rate is high in some studies (up to 50 percent at five years). 

 

Excision — Scalpel excision may be indicated if injection therapy alone is unsuccessful or unlikely to result in significant improvement. Excision should be combined with preoperative, intraoperative, or postoperative triamcinolone or interferon injections. Recurrence rates from 45 to 100 percent have been reported in patients treated with excision alone; this falls to below 50 percent in patients treated with combination therapy.

 

Silicone gel sheeting — Silicone gel sheeting has been used for the treatment of symptoms (e.g., pain and itching) in patients with established keloids as well as for the management of evolving keloids and the prevention of keloids at the sites of new injuries.

 

A systematic review of controlled trials found some evidence that silicone gel sheeting may reduce the incidence of abnormal scarring, but concluded that any estimate of effect was uncertain because the underlying trials were of poor quality and highly susceptible to bias. Treatment with silicone gel sheeting appeared in some studies to improve elasticity of established abnormal scars, but the evidence was again of poor quality and susceptible to bias.

 

Cryosurgery — Cryosurgery is most useful in combination with other treatments for keloids. The major side effect is permanent hypopigmentation, limiting its use in people with darker skin.

 

Radiation therapy — Most studies, but not all, have found radiation therapy to be highly effective in reducing keloid recurrence, with improvement rates of 70 to 90 percent when administered after surgical excision. A small randomized trial of treatments after surgery found recurrences in two of sixteen earlobe keloids (13 percent) treated with radiation therapy and in four of twelve earlobe keloids (33 percent) treated with steroid injections.

 

However, concern regarding the potential long-term risks (e.g., malignancy) associated with using radiation for an essentially benign disorder limits its utility in most patients. Only a few cases of malignancy that may have been associated with radiation therapy for keloids have been reported. Although causation cannot be confirmed in these cases, caution should still be used when prescribing radiation therapy for keloids, particularly when treating younger patients.

 

Radiation therapy may occasionally be appropriate as treatment for keloids that are resistant to other therapies. In addition, radiation therapy may be indicated for lesions that are not amenable to resection.

 

Interferon alpha — Interferon alpha injections may reduce recurrence rates postoperatively. However, all currently available studies of interferon therapy suffer from methodologic problems, making an evidence-based recommendation regarding its use difficult. 

 

Pulsed dye laser — Pulsed dye laser treatment can be beneficial for keloids, and appears to induce keloid regression through suppression of keloid fibroblast proliferation, and induction of apoptosis and enzyme activity. Combination treatment with pulsed dye laser plus intralesional therapy with corticosteroids and/or fluorouracil may be superior to either approach alone

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