Keloids and hypertrophic scars

Keloid on back and arm.

KELOIDS AND hypertrophic scars are skin lesions that occur due to the excessive production of repair tissue in response to injury. Dark-skinned individuals such as Africans, Afro-Caribbeans, Afro-Americans, Indians, and Chinese are more prone to developing these lesions.

Hypertrophic scars result from deeper injuries and remain confined to the site, whereas keloids extend beyond the injured area. Hypertrophic scars also flatten spontaneously with time whereas keloids do not. Minor injuries such as ear piercing and scalds to the skin, as well as other sources of inflammation like acne and scalp folliculitis may result in keloid formation.

The new fashion of body piercing practised by both males and females significantly increases the risk of keloid
formation.

Certain areas of the body are more prone to keloid formation, and these include the earlobes, chin area, upper back, chest area and the back of the neck.

Patients with keloids are at risk of developing further keloids and should try to avoid injury or unnecessary surgical procedures in the keloid prone areas. Keloids may be quite large and very extensive sometimes even affecting the internal organs due to constriction of vital structures depending on where they are located for example, keloid around the neck.

Keloids and hypertrophic scars may be painful or may itch but many seek medical attention because they consider them unsightly or cosmetically unacceptable.

TREATMENT

When treating keloids the earlier the treatment is started the better the results tend to be. For treating recently-developed keloids, one of the most effective treatments is to apply silicone sheets or gel in combination with steroid injections into the lesion. Older lesions can be surgically removed, followed by injection of the area with steroids or by radiotherapy treatments to prevent
recurrence.

Pressure application to the keloid is another form of treatment. This is usually achieved using pressure earrings or garments. Cryotherapy, which involves freezing the keloid for 10 to 15 seconds with liquid nitrogen, may also be helpful. Other modes of treatment include ultrasound and laser use, but these are more
expensive.

The sutures should not be placed tightly and should be removed as early as possible.

To reduce the incidence of keloids it is of value not only to avoid injury but also to keep wounds clean to prevent infection, with the use of antibiotic ointments and so on. A shortened healing time usually decreases the chance of keloid formation.

- Dr. Patricia Dunwell, consultant dermatologist

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