Keloid is abnormally large overgrowth of fibrous tissues (scar) occuring as a results of trauma or irritation that does not subside with time. In terms if genetics it is 5-15 times more common in blacks and Asian than in caucasians. In all races, more darkly pigmented individuals are at high risk. Both autosomal dominant and and autosomal recessive familial inheritance have been reported.
- Surgical or traumatic wounds ,body piercing
- Burns injury
- Insects bites
- folliculitis barbae and nachae
Common risk factor
- Family history of keloids
- Dark skin pigment
- Certain locations on the body, eg. deltoids, chest, earlobes
Signs and Symptoms;
- Pain at site of keloid scar
- Firm, smooth, elevated scar with sharply demarcated borders
- Keloid scar in early stages it may be pale or mildly erythematous.while the older lesions are either hypo-or hyperpigmented.
- Keloid scar extending beyond margins of the initial wound
- Sometimes over period of years, keloids may continue to grow and may develop claw-like projections.
- Infiltrating besal cell carsinoma
- Sclerosing metastatic malignincies
- Other fibronodular skin diseases
How to treat keloid scar
- Intralasional corticosteroid injection; this couses atrophy and is most successful therapy
- Application of pressure bandange maintained at 24 millimetre of mercury and should be worn for 6-12 months. Badange should not be removed for more than 30 minutes in day.
- Radiation: some it is reported to be safe and effective use of radiation to treat keloids.
- Tropical agents: No evidence to support efficacy; eg. retinoic acid, vitamin E,antineoplastic,silicon gel.
- Cryotherapy: Freezing keloids with liquid nitrogen may flatten them but often darkens or lightens the site of treatment.
Surgery has high recurrence rate of 45-100%, therefore used only for debulking of large keloids or if lesion is unresponsive to steroid injections.
Drug of choice for treatment of keloid;
- Triamcinolone such as kenacort,trinocort among others.using 27-30 gauge needle and a TB syringe (total dose 20-30 mg of triamcinolone). Healthcare provider may inject 3 lesions at a time, using 1omg/lesion.