Keloid : a strange disorder of skin

Keloid is an area of fibrous tissue formed at the site of injury. Keloid grow like ‘crab claw’ expanding over the normal skin. Keloids are known to Egyptian surgeons since 1700 BC. This term was first coined by Baron Jean-Louis Albert in 1806. (hptt://wikipedia.org/wiki/keloid) Since then scars are classified as normal scar, hypertrophied scar and keloid.

            A keloid may develop after a cutaneous injury, burn, cosmetic piercing, tattooing, insect bite, scratching or after scratching a pimple or acne. Some people are more prone to develop keloid. Keloids are equally common to men and women. In children and elderly people keloid generally do not develop. Keloids are found only in human being and occur in 5 to 15 % of wounds.

           Incidence of keloids are more in females compared to the males. Again it is noticed that incidence of keloids are 15 times higher in darker complexion compared to the fair skin. Keloids are seen in family members suggests a genetic link. Blood group A and HLA-B14, HLA-B21, HLA-BW16, HLA-BW35, HLA-D R5, HLA-DQW3 are found to be more prone to develop keloid. Still it is very difficult for a doctor to predict who will develop a keloid and when. Keloids develop mostly on chest, earlobes, shoulder, arms, pelvic region, back and over the collar bone. They are shiny, dome-shaped, raised from normal skin, and of pink to reddish color. Some keloids are quite large and looks ugly. Keloids are irregular in shape and having tendency to enlarge progressively.

         Normally after an injury a scar is formed due to natural healing process and that scar is usually flat. A hypertrophied scar never exceeds the boundaries of the wound, but they are redder, raised and often painful. Hypertrophied scar slowly regresses spontaneously in several months time. Any uncontrolled growth on skin may need biopsy to rule out skin cancer.

        Keloids are not harmful to health, but may be itchy and giving embarrassment to the person owing to anatomical location, that may be cosmetically unpleasant.

Treatment of keloid:

         It is very difficult to treat the large-sized keloid. It is wise to avoid elective surgery or cosmetic piercing in susceptible person to prevent development of keloid.     Decision of treating and mode of treatment of a keloid varies from person to person depending on the symptoms and its anatomical location.

 Steroid injection (Triamcelolone 10 mg)  on the keloid at monthly interval may flatten the keloid.

Surgical removal may trigger formation of a larger keloid, but steroid injection, pressure bandage and post surgical radiation have been helpful in some cases. Some keloids are treated by cryosurgery.

 Use of Interferron injection are helpful in regressing some keloids.

 Methotrexate, Flourouracil, Bleomycin and other chemotherapeutic agents have been tried to treat keloid.

Tracolimus, Colchicine, Pantoxyfylline and many other drugs have been tried.

Various topical agents are tried with limited success viz. Imiquimod, Mitomycin-c, topical zinc, cyclosporine, D-penicillamine, veraprimil, relaxin etc.

Unfortunately recurrence rate treated keloids are quite high and hence scientists are still trying to find out an ideal mode of treatment of keloid.