Keloid Scarring
Keloid scarring on the neck of a young man.
Keloid scarring arising from the antihelix of the ear. The blood is from a recent biopsy of the lesion.
Keloid scarring arising from the root of the helix.
This picture demonstrates the risk of keloid scar formation post ear-piercing. Again, the blood seen on the lesion is from recent biopsy.
This woman underwent excision of a facial naevus and subsequently developed keloid scarring. This is differentiated from hypertrophic scarring by the fact that the fibroid tissue has extended beyond the margin of the surgical scar.
This large keloid scar followed facial trauma. Note that dark skinned races experience a higher incidence of keloid scar formation.
Features
A keloid is defined as a benign, well demarcated area of fibroid tissue overgrowth that extends beyond the original defect.
Clinically, keloid scars appear as fleshy growths in areas of previous trauma. Lesions appear within 3-4 weeks of the causative stimulus (trauma, ear piercing, operative incisions etc.). The lesions are pink or red plaques, which can become very large and classically involve the earlobes, chin, neck or chest. They may grow for months or several years and then tend to spontaneously regress. Lesions can be hypersensitive or very tender.
In males, presternal lesions tend to have more irregular borders. In females, however, these lesions classically display a "butterfly" outline. This is thought to be caused by the lateral stress placed on the chest skin by the breasts.
Incidence
This varies with race, although individuals from all races can form keloid scars. That said, Keloids are seen with greater frequency in blacks, Hispanics, and Asians. Some black and hispanic populations are thought to have a prevalence as high as 16%.
A positive family history is also of importance. Of those with keloid scarring, particularly in those with severe lesions, 10-15% had a positive family history.
Certain groups such as acromegalics and young patients post-thyroidectomy are more prone to keloid scar formation.
Aetiology
The cause is not known, but both environmental and genetic factors are thought to play a part.
Differential Diagnosis
Scarring acne (on the trunk). Fibrosarcoma. Basal cell carcinoma. Lupus perinio. Dermatofibrosarcoma.
Treatment
Avoidance of unessential trauma to the sites of predilection in those who are predisposed to keloid scarring is the ideal. However, this is not always possible.
Intra-lesional triamcinolone, pressure bandaging or clipping, pre-op site radiotherapy and silicon gel have all been found to be of use.
