Keloid - A Rare Skin Disease

Dr. BHASKARCHAKRABORTY Professor of Chemistry Sikkim Government College (NBBGC) An Extension Centre

What is Keloid?

A keloid is a kind of overgrown scar or an overly aggressive healing response to a wound.Scars, which form as a response to a wound such as a minor burn, cut or abrasion are part of the body’s natural healing process. In most cases, scars usually grow smaller and fade over time but in some people, the skin can overreact to the damage and lead to scars that are much larger than the original wound. These scars are called keloids.Keloid scars, which are typically thick and irregular, rarely go away on their own. They can be challenging to treat, which is why dermatologists emphasize the importance of preventing keloids from forming in the first place, according to the American Academy of Dermatology Association (AADA).

How Keloid is developed & what are its symptoms?

It appears gradually. It can take as long as 3 to 12 months or even longer before you to notice a keloid beginning to develop or tend to appear within a year of the original skin damage.It may also grow quickly. Sometimes keloids spread fast. For example, it becomes triple in size within a few months. Keloids are itchy, tender or painful. The symptoms usually stop once the keloid is developed.It may become irritated from friction, such as rubbing against clothing.It gradually turns darker. A keloid typically begins as a pink, red or flesh colored scar that darkens over time and ends up looking darker than the skin around the scar.

Which areas are of our body are prone to keloid development?

Keloids can occur anywhere in our body but, according to the AADA, they are less common on the eyelids, genitals, soles of the feet or palms of the hands.They frequently develop on the ears, neck, shoulders, chest and in the back. Keloids can be more than just skin imperfections. Depending on the size of the scar and where it is on the body, it can affect how well we can move that area of the body. For some people, physical symptoms such as pain or itchiness can impact our psychological health. Others may feel that their keloid is noticeable or unsightly and that may take a toll on their emotional well being.It’s not clear why some people develop keloids but doctors believe that these types of scars form when fibroblast cells found in our connective tissue that secrete collagen which overreact and produce high amounts of collagen in response to a wound. If someone is prone in developing keloids, any type of skin injury that can cause a scar can lead to the formation of a keloid.

Different types of Keloids in our body

What are the causes of developing keloids?

Some common causes of keloids include:Surgical cuts or any other types of cuts likeacne and chickenpox blemishes or scars, burns, body or ear piercings, tattoos, insect bites. Vaccination shots and wearing tightly braided hair. In rare cases, keloids can form on skin that hasn’t been injured. These are referred to as spontaneous keloids.

Who are prone to keloids?

The American Association of Dermatologists (AAD)  identifies certainreasons as risk factors that may increase developing keloids which includes heredity as well. African, asian or hispanic descent, having a family history of keloids, age between 10 and 30 years old. Most people begin to notice keloids developing on their skin in their twenties, although these scars can start earlier or later.Keloids are usually diagnosed by a dermatologist who takes patients medical history and conduct a visual examination of the scar to check its size, shape and growth pattern. Doctor may also perform a skin biopsy to rule out more serious conditions such as nodular scleroderma, a type of connective tissue disease or lobomycosis, a fungal infection of the skin.

Prognosis of Keloids

Majority of the growth of  keloids are benign (noncarcinogenic) but few keloids are difficult to treat and frequently grow back even after they are surgically removed. But dermatologist may be able to suggest measures that can help to reduce the odds of keloids returning after treatment or at least ways to minimize their appearance.Keloids can continue to grow for months or even years. They eventually stop growing but they do not disappear without treatment. In some cases, keloids can return after they have been removed.Keloids generally do not need to be treated. But treatment may be helpful if a keloid scar causes discomfort or hampers movement (if it covers a joint or a large area). People may also seek treatment for a keloid if the scar impacts their self esteem and how they feel about their appearance. For instance, if the scar is large or is located in a very visible place on our body, we oviously feel bad. In this cases patient may contact a dermatologist for a solution who can treat either using medication of by surgery to reduce the size and prominence of the keloid. There is no treatment that works best for all keloids. Dermatologists typically tailor the treatment to the individual based upon factors such as age and type of keloid. Keloids are difficult to banish completely and using more than one type of treatment often improves results. Dermatologists therefore often recommend two or more types of treatments for their patients. Few treatment procedures are:

Cryotherapy: This treatment, which works best on small keloids, involves freezing the keloid from the inside out. This method is often used before or after corticosteroid injections to help make the injections more effective.Pressure Therapy: This involves using a device or a special piece of clothing to put pressure on the area and reduce blood flow to the site to inhibit the regrowth of the keloid. While effective, this treatment, which is often used after surgery, can be difficult for many people to stick to. These devices can be uncomfortable and people need to wear them for 6 to 12 months.Radiation Therapy: In this treatment, the keloid is surgically removed and low-dose radiation is used to prevent scar tissue from regrowing.Laser Therapy: This treatment uses high-energy light beams to reduce the size and lighten the color of a keloid. Laser therapy is commonly combined with other treatments such as corticosteroid injections or pressure therapy.Silicone Gels and Patches: These silicone-based treatments help flatten and reduce the size and color of the scars.

Ligature: Doctor may opt to use a surgical thread to tie around the keloid, which cuts off the blood supply so that the keloid will naturally fall off after a period of time.Surgery: Surgery is typically combined with other therapies such as corticosteroid injections or silicone treatments. It’s because in nearly 100 percent of cases, keloids grow back after surgical removal. Corticosteroid Injections: These injections are administered into the keloid to help reduce inflammation and constrict blood vessels, which may help relieve swelling, itchiness or tenderness.

Fluorouracil: This chemotherapy medication, which is usually used to treat cancer, may be used in conjunction with corticosteroids.While there are a number of products on the market that claim to be effective for prevention or treatment of keloids, but no research studies till date provides solid evidence to support those claims.

Prevention of Keloids

If someone is prone in developing keloids, he or she has to be vigilant about taking steps to prevent the formation of these scars. American dermatologists association have suggested few tips to prevent keloids. These are: to avoid body piercings, tattoos or any elective surgery, as keloids can occur after these procedures.Treat any injury right away, no matter how minor it is. This may help our skin heal faster and reduce risk of scarring.If we have a wound, we should consult with a dermatologist about how to treat the wound, take care and dress it. This will help us to prevent keloid scars from developing.People who have darker skin have a higher risk for developing keloids than people with fairer complexions. Researchers are working in various American and European Medical Institutions to learn more about how genetics (specific genes) may play a key role in keloid formation. Hope one day, we may be able to find new treatment methods of diagnosis, prevention and treatment for this skin disease.

Courtesy:

Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018.

James WD, Elston D, Treat JR, Rosenbach MA. Andrew’s Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2019.