Keloid
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A postoperative keloid on the wrist that was treated with triamcinolone intralesional injection. The sunken erythema area on the left side is the treated area.
Linear Keloids. When they occur on the upper front of the torso, they often appear in a linear shape.
Posterior auricular Keloid
Keloids on the soles of the feet can be uncomfortable to walk on.Intralesional steroid injections are usually performed several times.
Keloids are commonly observed on the upper arms.
Typical manifestation of chest keloids.
References
Keloids result from abnormal wound healing in response to skin trauma or inflammation. Keloid development rests on genetic and environmental factors. Higher incidences are seen in darker skinned individuals of African, Asian, and Hispanic descent. Overactive fibroblasts producing high amounts of collagen and growth factors are implicated in the pathogenesis of keloids. As a result, classic histologic findings demonstrate large, abnormal, hyalinized bundles of collagen referred to as keloidal collagen and numerous fibroblasts. Keloids present clinically as firm, rubbery nodules in an area of prior injury to the skin. In contrast to normal or hypertrophic scars, keloidal tissue extends beyond the initial site of trauma. Patients may complain of pain, itching, or burning. Multiple treatment modalities exist although none are uniformly successful. The most common treatments include intralesional or topical steroids, cryotherapy, surgical excision, radiotherapy, and laser therapy.
Current literature supports silicone gel or sheeting with corticosteroid injections as first-line therapy for keloids. Adjuvant intralesional 5-fluorouracil (5-FU), bleomycin, or verapamil can be considered, although mixed results have been reported with each. Laser therapy can be used in combination with intralesional corticosteroids or topical steroids with occlusion to improve drug penetration. Excision of keloids with immediate post-excision radiation therapy is an effective option for recalcitrant lesions. Finally, silicone sheeting and pressure therapy have evidence for reducing keloid recurrence.
There continues to be no gold standard of treatment that provides a consistently low recurrence rate; however the increasing number of available treatments and synergistic combinations of these treatments (i.e., laser-based devices in combination with intralesional steroids, or 5-fluorouracil in combination with steroid therapy) is showing favorable results. Future studies could target the efficacy of novel treatment modalities (i.e., autologous fat grafting or stem cell-based therapies) for keloid management.
Scars are a natural and normal part of healing following an injury to the integumentary system. Ideally, scars should be flat, narrow, and color-matched. Several factors can contribute to poor wound healing. These include but are not limited to infection, poor blood flow, ischemia, and trauma. Proliferative, hyperpigmented, or contracted scars can cause serious problems with both function and emotional well-being.
Keloid scars are seen more frequently in people of African, Asian, or Hispanic descent. People between the ages of 10 and 30 years have a higher tendency to develop a keloid than elderly.
Although they usually occur at the site of an injury, keloid can also arise spontaneously. They can occur at the site of a piercing and even from something as simple as a pimple or scratch. They can occur as a result of severe acne or chickenpox scarring, infection at a wound site, repeated trauma to an area, excessive skin tension during wound closure or a foreign body in a wound.
Keloid scars can develop after surgery. They are more common in some sites, such as the central chest (from a sternotomy), the back and shoulders (usually resulting from acne), and the ear lobes (from ear piercings). They can also occur on body piercings. The most common spots are earlobes, arms, pelvic region, and over the collar bone.
Treatments available are pressure therapy, silicone gel sheeting, intra-lesional triamcinolone acetonide, cryosurgery, radiation, laser therapy, Interferon, 5-FU and surgical excision.
○ Treatment
Hypertrophic scars can improve with 5 to 10 intralesional steroid injections 1 month interval.
#Triamcinolone intralesional injection
Laser treatment may be tried for erythema associated with scarring, but triamcinilone injections can also improve the erythema by flattening the scar.
#Dye laser (e.g. V-beam)