Preventing and managing Keloids
Consultant Dermatologists at University College Hospital, Ibadan, Prof. Adebola Ogunbiyi, in this interview with GERALDINE AKUTU, spoke on keloids and its management.
What are keloid scars?
Keloids are abnormal scar tissue formed at sites of trauma. Normally, when the skin has injury, it tries to repair. In the process of repairing, it forms some abundant tissue, which develops into keloids. Because keloids are found on the sites of really repaired tissue, you tend to find them on the site of previous injury and trauma. That is why you tend to find them when people pierced their ears or on the earlobe after injury or cuts. Already, we have predilections for certain areas.
Another thing about keloids is that they tend to overgrow the sites of injury. There is something similar to keloids called the hypertrophic scar. When you have a hypertrophic scar, it tends to keep within the sites of the injury, but the keloids get excessive and grow beyond the sites of injury. Keloids are commoner in blacks. So, you will find out that out of all the races blacks tend to have a prevalence of keloids, which tend to occur mostly after puberty between the ages of 10 and 45. However, we have few kids that tend to develop keloids.
How does keloid occur?
Keloids tend to occur on areas where there is tension and injury. So, we tend to find them on the anterior chest, where the skin is a bit tensed. The flexor surfaces of the extremity are areas where you have flexures in the body and crossed skin tension lines. So, the commonest areas affected by keloids are the chest, shoulders, earlobes, and anywhere else where there is injury from burns and accidents.
Keloids develop one year after injury. It is not a hypertrophic scar because it goes way beyond the injury. Most keloids develop after the trauma of the wound. Most people who have keloids complain of excessive scar tissue, which usually tends to be associated with itching. There are times that the growth rate is large. Some of them can have necrosis. So, you can actually have wounds within the keloid, further stressing the individual that has it. It is also known that the way the wound is managed can predispose one to keloid formation. There are people who had no history of keloids, but later have it. There is something that incites the development of keloids in a particular area.
Does keloid have genetic tendency?
It is known that keloids have a generic tendency. So, a good number of people that have keloids tend to have a family history. Once you know there are people that have keloids in your family, then you have to be careful with regards to intentional trauma like piercing your ears, tattoos and unnecessary surgeries.
How is keloid diagnosed?
Diagnosis is made clinically, especially on examination of a patient presenting with a swelling, you look for the location of the swelling. There are factors one looks at. You may notice that no hair is growing on the region and they tend to be shiny. If there is a previous swelling of a wound, you will notice that the swelling has grown beyond the area of the wound and some of them grow in such a way that people describe them as crabs. When diagnosis is in doubt, then go for biopsy. A Biopsy means that you take part of the skin.
What are the treatment options?
Treatments for keloids will vary. There are so many things to be considered, such as types of keloid and the location of the keloid, among others. All these will matter in treatment. Although trauma is one of the things that set up a keloid, when you have a patient that has very large keloids, some of them need to be excised. You must bear in mind that trauma makes it worse.
There are other precautions that are done quickly after the surgery. There are drugs, steroid injections that can be used, X-rays to prevent excessive growth of keloids. There is a possibility of the keloids occurring again, but the beautiful thing is that once the patient notices keloid, treatment can be initiated. Keloids can be frozen or exposed to laser therapy. Even in some instances when they are available, patients with keloids can be given immunotherapy, interferon therapy and drugs like Fluorouracil (5-FU).
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