“It’s Embarrassing………Please Help!”

Introduction

Keloid is a sharply elevated, irregularly shaped, progressively enlarging scar, due to excessive collagen formation in the process of tissue repair and wound healing. They may occur anywhere on our body. They most commonly developed on the earlobes, arms, pelvic region and chest.

Keloids are scar tissue. In natural wound repair, collagen tends to overgrow in this area, sometimes producing a lump many times larger than that of the original scar. They occur following an injury to the skin.

Keloid is common in young people between the ages of 10 and 20, and among African American, Asian, and Hispanics. It is unclear why keloids are more common in people with darker skin. Keloids are equally common in men and women

Keloids tend to have a familial tendency which means one is more likely to have keloids if one or both of the parents has them.

Causes

The most common cause of keloid is trauma, commonly injury to the skin following ear piercing. Other known causes of keloid formation are:

1. Severe acne
2. Burns
3. Infection at wound site
4. Scarring on skin post chickenpox
5. Foreign body in a wound
6. Repeated trauma to an area of the skin
7. Excessive skin tension during wound closure after surgery
8. Vaccination sites

Although they usually occur at the site of an injury, keloid can also arise spontaneously.

Clinical Features

These growths can cause itching or burning sensation and often become a source of discomfort, tenderness or embarrassment. The presentation may include:

1. Abnormal dark/brownish swelling over the skin
2. Hyper sensitivity of skin – possible irritation from clothing or other forms of friction
3. Burning skin sensation
4. Itchy patch of skin
5. A lumpy or ridged area of skin

Figure 1: Ear Keloid

Keloids expand in claw-like growths over the normal skin. They have the capability to hurt with a needle-like pain or to itch without warning, although the degree of sensation varies from person to person. If the keloid becomes infected, it may ulcerate.

Treatment

When Is keloid removal necessary?

Removal of ear keloid is often for cosmetic reason, rather than a health issue. The decision to have a keloid surgically removed depends on the patient.

Small keloid may respond to a series of steroid injections, which can be done in the outpatient clinic. Large keloid is generally excised, as long as the patients and their parents accept the risk that the keloid may recur.

There are other methods of removing keloids, apart from surgical excision such as:

1. The use of liquid nitrogen to freeze and kill the skin cell
2. Laser therapy
3. Radiation therapy to shrink the cell
4. Steroid injection
5. Moisturizing oils to keep the tissue soft

Radiation therapy after operation, injections of steroid, pressure dressing or dressing with silicon sheet are also known to decrease the risk of recurrence.

How It Is Removed?

Depending upon the age of the person, the size of the keloid and pain threshold level, a surgical excision may be performed using injection of local anesthesia (LA) For those who cannot tolerate LA, the procedure may be done under general anaesthesia.

It is a short procedure which involves removal of the keloid followed by restoration of the skin around the earlobe. Most patients can return to work or home within same day of the operation.

Can It Recur?

Yes, it can recur. Surgical excision may lead to recurrent keloid scar formation, sometimes even larger than the original keloid.

To reduce the risk of recurrence, the surgeon may choose to inject the edges of the wound with steroid medication before wound closure, and patients may also benefit from the use of pressure earrings, when the wound has healed. Additional steroid injections may be indicated if the scars begin to thicken in the months following surgery.

Sun exposure or tanning may discolor the scar tissue, making it slightly darker than your surrounding skin. This can make the keloid stand out even more than it already does. Keep the scar covered when you are in the sun to prevent discoloration.

Watch Video Here

References

1. Babu, M; Meenakshi, J; Jayaraman, V; Ramakrishnan, KM (2005). “Keloids and hypertrophic scars: A review”. Indian Journal of Plastic Surgery 38 (2): 175–9. doi:10.4103/0970-0358.19796.
2. Ogawa, Rei (2010). “The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids”. Plastic and Reconstructive Surgery 125 (2): 557–68. doi:10.1097/PRS.0b013e3181c82dd5. PMID 20124841.
3. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 1499. ISBN 1-4160-2999-0.
4. Wound Healing, Keloids at eMedicine