What is Keloid?

·        Keloid is common in blacks.

·         Common in females.

·         Genetically predisposed.

·         Often familial. Very rare in Caucasians.

·         There is a defect in maturation and stabilization of collagen fibrils.

·         Normal collagen bundles are absent.

·         Keloid continues to grow even after 6 months, maybe for many years. It extends into adjacent normal skin.

·         It is brownish-black/pinkish black(due to vascularity) in color, painful, tender and sometimes hyperaesthetic; spreads and causing itching.

·         Keloid may sometimes be associated with Ehlers-Danlos syndrome or scleroderma.

·         When keloid occurs following an unnoticed trauma without scar formation it is called a spontaneous keloid, commonly seen in negros.

·         Some keloids occasionally become nonprogressive after initial growth.

·         Pathologically, the keloid is made up of proliferating immature fibroblasts, proliferating immature blood vessels and type III thick collagen stroma.

Sites:
 Common over sternum.
 Other sites are the upper arm, chest wall, lower neck front

Differential diagnosis: Hypertrophic scar

Treatment: Controversial

·        Steroid injection: Intrakeloidal triamcinolone(stops the fibroblast proliferation and the collagen synthesis)- at regular intervals, once in 7-10 days;6-8 injections.

·        Steroid injections-excision-steroid injection.

·        Methotrexate and vitamin A therapy into the keloid

·        Silicone gel sheeting; topical retinoids.

·        Laser therapy

·        Vitamin E/Palm oil massage.

·        Intralesional excision retaining the scar margin may prevent recurrence and is ideal and better than just excision.

·        Irradiation with or without excision

·        Excision and skin grafting may be done