Keloid Scars - A Brief Discussion

Keloid scars are tumor like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original wound

Predisposing factors

• ethnicity: more common in people with dark skin
• occur more commonly in young adults, rare in the elderly

Pathophysiology: When skin is injured, fibrous tissue, called scar tissue, forms over the wound to repair and protect the injury. In some cases, scar tissue grows excessively, forming smooth, hard growths called keloids. Keloids can be much larger than the original wound.

Common Sites (in order of decreasing frequency):

• sternum, 
• shoulder,
• neck,
• face, 
• extensor surface of limbs, 
• trunk

Keloids should not be confused with hypertrophic scars, which are raised scars that do not grow beyond the boundaries of the original wound.

Clinical Features:  The symptoms of keloids can include:

• a localized area that is flesh-colored, pink, or red in color
• a lumpy or ridged area of skin that’s usually raised
• an area that continues to grow larger with scar tissue over time
• an itchy patch of skin

Keloid scars tend to be larger than the original wound itself. They may take weeks or months to develop fully.

While keloid scars may be itchy, they’re usually not harmful for health other than cosmetic problems.

Keloid scars are less likely if incisions are made along relaxed skin tension lines (Langer lines were historically used to determine the optimal incision line. They were based on procedures done on cadavers but have been shown to produce worse cosmetic results than when following skin tension lines

Treatment

• early keloids may be treated with intralesional
• steroids e.g. triamcinolone
• excision is sometimes required