Keloids

The Institute for Advanced Reconstruction specializes in the removal of keloids. Keloids are abnormal scar tissue caused by trauma, surgery or certain skin conditions. The word is coined from the Greek word chele for crab claw, as some keloids have claw-like, irregular borders that extend over the skin and beyond the original wound area. They are commonly a result of chickenpox, ear piercing, vaccination sites, and acne. Keloids can be much larger than the original wound, and are most commonly found on the upper chest and shoulders, back and earlobes. They rarely develop on the face (with the exception of the jawline).

Keloids, however can affect any part of the body. They can range from small, to a size so large they can inhibit movement or range of motion. Keloids are often associated with development following minor injuries that occur with body piercing. Keloids may continue to grow slowly for weeks, months or years. They eventually stop growing but do not disappear on their own. Once a keloid develops, it is permanent unless removed or treated successfully. Unfortunately, it is common for keloids that have been removed or treated, to return.

Types of Scars

Scarring is part of the body’s natural healing process following an injury or wound. A scar, usually composed of fibrous tissue, serves as a replacement for lost or damaged skin.

The nature of scarring depends on various factors, from the type of the wound (size, depth and location) to age, gender, ethnicity and genetics.

There are various category breakdowns for types of scars. The main ones include:

Atrophic scars (from atrophy, meaning a decrease in size) result in a depression or sunken area. They are caused, for example, by acne, chickenpox or injury.

Contracture scars are caused by a tightening of the skin. If the skin has been burned, it may result in a contracture scar.

Hypertrophic scars (meaning enlargement of the tissue) are raised, red scars that are similar to keloids, but differ, as they do not extend beyond the boundary of the wound.

Keloid scars are relatively highly elevated, with irregular shape, which enlarge progressively outside the area of the wound.

A keloid may be:

  • Flesh-colored, red, or pink
  • Located over the site of a wound or injury
  • Lumpy (nodular) or ridged
  • Tender and itchy
  • Irritated from friction such as rubbing on clothing

The actual term “keloid” was defined by French dermatologist, Baron Jean Louis Alibert in 1806. “Cheloide” was the term used by Alibert. However, keloids were described by Egyptian surgeons around 1700 BC. This was discovered in a 1930 translation from a papyrus from ancient Egypt detailing surgery at that time.1

Keloids are equally common in women and men, although in times past, more women developed them because of a greater degree of earlobe and body piercings. Keloids are less common in children and the elderly. According to the National Center for Biotechnology Information, keloid scarring is common in people between the ages of 10 and 20, and also among African Americans, Asians, and Hispanics. Approximately 16% of these population groups have them. This is about 15 times higher than in Caucasian populations.2

It is also known that genetic factors play a role in who is more likely to get these types of scars. Keloids are often more of a cosmetic concern than a health one. You may feel self-conscious if the keloid is very large or in a highly visible location, such as an earlobe or on the face.

Although keloids typically do not require medical attention, you may want to contact your doctor if growth continues, or if you develop additional symptoms. While keloids are benign, uncontrolled growth may be a sign of skin cancer. After diagnosing keloid scarring with a visual examination, your doctor may want to perform a biopsy to rule out other conditions, such as skin cancer. This involves taking a small sample of tissue from the scarred area and analyzing it for cancerous cells.

Causes of Keloids

Possible causes of keloids:

  • Acne scars
  • Burns
  • Chickenpox scars
  • Ear piercing
  • Scratches
  • Surgical cuts
  • Vaccination sites

Keloid Treatment

Treatment choice depends on many factors, including the size, location and depth of the keloid, your age, and what treatment, if anything, has been previously tried.

Keloids are traditionally treated by some or a combination of the following:

  • Corticosteroid injections
  • Freezing (cryotherapy)
  • Laser treatments
  • Radiation
  • Surgical removal
  • Compression therapy
  • Silicone gel or patches

However, most treatments do not produce permanent results and the growths tend to re-appear, and may be larger than the original scar. While keloids can return in those people who have had them surgically removed, they are less likely to return if surgical removal is combined with other treatments. That’s why for particularly troublesome keloids, The Institute for Advanced Reconstruction experts use a surgical approach in combination with radiation. This is a very low dose radiation that minimizes any cancer risk, and our experts recommend it only for extremely difficult cases in which all other methods have been thoroughly exhausted. We work with radiation and other specialists to determine the optimum course of treatment for an individual, on a case by case basis—so those who suffer now have a place to turn to for a solution.

In a summary of this procedure published in the Journal of the American Academy of Dermatology and reviewed by the National Institutes of Health3, researchers concluded, “Surgery does have statistical evidence as being very effective in the treatment of keloids. According to the evaluation of 126 keloids, with a follow up 12 years after treatment of keloids, surgical excision followed by radiation therapy provides the highest reported control rates of 72% to 92%. Excision followed by radiation therapy is a useful and effective method of keloid eradication, particularly in cases in which lesions are disfiguring or unmanageable or resistant to other processes. Still, radiotherapy is typically reserved as a last choice for otherwise unresponsive keloids by most doctors.”

Sources

2http://emedicine.medscape.com/article/876214-overview#aw2aab6b4
3http://www.ncbi.nlm.nih.gov/pubmed/8040405



More Information

At The Institute for Advanced Reconstruction at The Plastic Surgery Center, we offer treatments for keloids to improve the quality of life of our patients. An initial consultation with our experts will assist in evaluating each individual case.

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