Prevent the formation of keloids (a previous keloid means risk for new keloids).
Treat keloids that cause aesthetic or mechanical problems or symptoms as fresh as possible. A newly formed keloid is easier to treat than an old one.
Definition
A keloid is a pathological, nonneoplastic tumour that may appear without a specific cause or as a consequence of minor skin injuries; including surgical wounds (pictures 123), earring holes (picture 4), acne scars on the trunk (picture 5)
A celoid consists of thick, well-defined, often erythematous lumpy formations that may coalesce into larger plaques. It usually spreads clearly beyond the original injury and has poor spontaneous healing tendency.
Areas with increased risk include auricles of the ears, the upper part of the chest and shoulders.
There is usually a a strong hereditary predisposition.
A hypertrophic scar denotes excessive growth of scar tissue during the healing process that does not extend beyond the injury and is usually clearly smaller than a keloid.
Initially erythematous lumpy formations and plaques develop at the site of the original injury and their size and form matches that of the injury. They often develop in wounds that are exposed to pulling forces or mechanical tension or irritation.
Typical examples include surgical scars (e.g. cesarean section) and scars caused by injuries and burns.
Over time, the scars will flatten out and their colour fades. These scars do not have as strong a hereditary basis as keloids do.
Distinguishing between keloids and hypertrophic scars is not possible in all cases, but the therapeutic principles are the same. In the case of hypertrophic scars, it is often a good idea to wait for spontaneous healing or for the scars to flatten.
Diagnosis
A typical case is easy to recognise. A keloid is at first a rubber-like, red, later dark red, solid, often tender, smooth growth of connective tissue covered by thin skin (picture 6).
The size can vary from a very small one to the size of an orange.
A benign hypertrophic scar(picture 7) becomes soft and smaller within 6 months, whereas a keloid does not.
Some cases occur familially.
Typical features
Excessive scar formation is detected within 3-4 weeks from the injury. The growth may continue for months or years.
Young women (from puberty to the age of 30) are at the greatest risk.
Wound infection and tension increase the risk for keloid formation.
The predilection sites include earlobes (holes!), upper trunk (particularly over the sternum), shoulders, chin, neck, and lower limbs. The palms, soles, and facial skin are less frequent sites.
Indications for treatment
Aesthetic harm
Restriction of skin motion, tenderness, or severe itch
Treatment
Simple excision without, e.g., pressure dressing or silicone gel sheet usually provokes a new keloid.
Glucocorticoid injections or a combination of liquid nitrogen cryotherapy and glucocorticoid injections have yielded varying results Ehttp://www.dynamed.com/condition/keloid-and-hypertrophic-scar#CORTICOSTEROID_INJECTIONS. The keloid is frozen thoroughly with liquid nitrogen spray. After 5 minutes the swollen keloid is infiltrated with e.g. triamcinolone 7.5 mg. The treatment is repeated 1-2 times at 6-week intervals.