What is Keloid?

Keloids are hard, rubbery lesions or glossy, fibrous nodules that range in colour from pink to the skin's tone or red to dark brown. The formation of a keloid scar, also known as keloid disorder or keloid scar, is the production of a type of scar that is mostly formed of type III (early) or type I (late) collagen, depending on its maturity. It occurs when granulation tissue (collagen type 3) overgrows at the site of a healed skin injury and is gradually replaced by collagen type 1. 


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A keloid scar is harmless and not contagious, although it can cause extreme itching, pain, and textural changes. It can impair skin movement in severe circumstances. Keloid scars are 15 times more common in people of Sub-Saharan African heritage than in those of European heritage in the United States. These elevated scars can affect men and women of African, Asian, and Hispanic origin all across the world. Some people, however, have a higher risk of developing a keloid when they scar, such as those who have a family history of keloids and those aged 10 to 30.


Symptoms of Keloid skin

  • Keloids form claw-like growths on the surface of normal skin. 

  • They can itch or hurt with a needle-like pain, with the intensity of the experience ranging from person to person.

  • Keloids are a type of scar tissue that forms keloids. Collagen, which is employed in wound healing, tends to overgrow in this area, resulting in a lump that is several times larger than the initial scar. 

  • They come in a variety of colours, from pink to red. Keloids can develop spontaneously, albeit they usually do so near the site of an injury. 

  • They can develop as a result of a piercing or even as a result of a pimple or abrasion


Keloid Locations on Body

Keloids can appear anywhere on the body where there has been skin damage. Pimples (keloid acne scar), bug bites, scratching, burns, and other skin injuries can all cause them. After surgery, keloid scars might form. Some areas, such as c-section (keloid c section scar), the middle chest (from a sternotomy), the back and shoulders (typically from acne), and the ear lobes, are more common (from ear piercings). They can also happen as a result of body piercings. 

Keloid on nose, Earlobes, arms, the pelvic region, and across the collarbone are the most prevalent places. Keloid ear piercing is prevalent after ear piercings and can appear on the lobe as well as the cartilage.


Causes of Keloids

  • They can be caused by severe acne or chickenpox scarring.

  • It can be caused by a wound infection.

  • By repetitive trauma to a region.

  • By high skin tension during wound closure, or a foreign body in a wound.

  • Scarring can be caused by almost any sort of skin injury. 

  • By burning.

  • By ear piercings, scrapes, surgical incisions, and vaccination sites are all examples of this. 

  • Keloids can be susceptible to chlorine in some cases. If a keloid develops while a person is still developing, the keloid might also continue to expand.


Characteristics of Keloid

Keloid scarring is widespread in young people between the ages of 10 and 20, according to the (US) National Center for Biotechnology Information. According to studies, those with darker skin are more likely to develop keloid scarring as a result of skin trauma. They affect 15–20 percent of people of Sub-Saharan African, Asian, or Latino descent, substantially fewer people of Caucasian heritage, and no cases of albinism have been identified. 

Keloids have a genetic component, which implies that if one or both parents have keloids, you're more likely to get them. However, while no single gene has been identified as a cause of keloid scarring, multiple susceptibility loci, most notably on Chromosome 15, have been uncovered.


Genetics of Keloids

People with Sub-Saharan African, Asian, or Latin American ancestry are more likely to develop a keloid. The keloid is the most frequent skin disorder among ethnic Chinese in Asia. Keloids are more frequent among African Americans and Hispanic Americans than among whites in the United States. People with a family history of keloids are also at risk since roughly one-third of those who develop keloids have a first-degree blood relation (mother, father, sister, brother, or child) who also develops keloids. People of African and/or Asian origin are more likely to have this family trait.

The presence of a genetic propensity to develop keloids is further supported by the development of keloids in twins. Four sets of identical twins with keloids were reported by Marneros et al. A pair of twins who developed keloids at the same time following vaccination was also described. Clinically severe forms of keloids have been found in persons with favourable family history and black African ethnicity in case studies.


Pathology

Keloids are fibrotic tumours with a collection of atypical fibroblasts and excessive deposition of extracellular matrix components, particularly collagen, fibronectin, elastin, and proteoglycans, on histological examination. In the deep dermal region of the lesion, they usually have relatively acellular cores and thick, plentiful collagen bundles that form nodules. 

Keloids pose a treatment challenge since they can cause substantial discomfort, pruritus (itching), and physical deformity. They may not improve in appearance over time and, if placed over a joint, can hinder mobility. In highly pigmented people, the incidence of occurrence is 15 times higher. Keloid formation is more common in people of African origin.


Study of Keloid in Population

A keloid can affect anyone at any age. Keloids are less likely to form in children under the age of ten, even if they have their ears pierced. Pseudofolliculitis barbae can also produce keloids; shaving with razor bumps causes irritation, infection, and keloids over time. 

People who have razor bumps should cease shaving for a few days to allow their skin to heal before attempting any type of hair removal. It's thought that the proclivity to create keloids is inherited. Keloids can appear to expand without piercing the skin over time, nearly acting out a gradual tumorous growth; the explanation for this is unknown.

Extensive thermal or radiological burns can result in extremely large keloids, which are especially common in firebombing victims and were a trademark outcome of the Hiroshima and Nagasaki atomic blasts. In the United States, the true frequency and prevalence of keloid are unknown. Indeed, no population study has ever been conducted to investigate the epidemiology of this illness. 

The reported incidence of keloids in the general population ranges from a high of 16 percent among the adults in Zaire to a low of 0.09 percent in England Marneros said in 2001, citing Bloom's 1956 study on keloids heredity. Clinical findings reveal that the disease is more common in Sub-Saharan Africans, African Americans, and Asians, with estimates ranging from 4.5 to 16 percent.


Treatment of Keloid

In patients with known susceptibility to keloid scars, avoiding needless trauma or surgery (such as ear piercing and elective mole excision) is the best way to avoid them. In susceptible individuals, any skin problems (e.g., acne, infections) should be treated as soon as possible to reduce irritation. Keloid removal cost can vary according to the severity of the condition.

Pressure therapy, silicone gel sheeting, intralesional triamcinolone acetonide (TAC), cryosurgery (freezing), radiation, laser therapy (PDL), IFN, 5-FU, surgical excision, and a variety of extracts and topical medicines are among the possible treatments (both preventive and therapeutic). Note that keloid scar treatment is age-dependent: in order to avoid negative side effects such as growth anomalies, radiation, anti-metabolites, and corticosteroids are not indicated for usage in children. 

Keloids can be treated, so it's not a condition you'll have to live with for the rest of your life. permanent keloid removal can be done by the procedure using superficial radiation to remove keloid scars and is quite effective. The SRT-100TM has a success record of over 90% in removing keloid scars.

The administration of intense cold to cure keloids is known as cryotherapy (or cryosurgery). This therapy procedure is simple to use, effective, and safe, with a low risk of recurrence.

For a large number of keloid lesions, surgical excision is still the most common treatment. However, when utilised as a stand-alone treatment, it has a high recurrence rate of 70 to 100 percent. Recurrence has also been observed to result in the creation of a bigger lesion. While surgical excision is not always successful on its own, when combined with other treatments, it greatly reduces the likelihood of recurrence. 

Radiation therapy, pressure therapy, and laser ablation are only a few examples of these treatments. Pressure therapy after surgical excision has demonstrated to be effective, particularly in the treatment of keloids of the ear and earlobe. The actual process of how pressure therapy works are unknown at this time, however, it has helped many people with keloid scars and lesions.

Intralesional corticosteroid injections, such as Kenalog (triamcinolone acetonide), seems to help reduce fibroblast activity, inflammation, and pruritus. 


Did You Know?

  • Keloid lesions are unaffected by tea tree oil, salt, or any other topical oil.

  • Keloids affect both men and women equally, albeit the incidence of keloids in young female patients has been observed to be higher than in young male patients, likely due to the higher frequency of earlobe piercings in women.

  • Acne keloidalis nuchae (AKN) is a disorder in which the scalp has been inflamed for a long time, resulting in scarring and hair loss around the nape of the neck and occipital regions (back of the head).

FAQs (Frequently Asked Questions)

1. What is Keloid Composed of?

Answer: A keloid scar is made up of 'connective tissue,' which is composed of gristle-like fibres produced in the skin by fibroblasts to keep the wound closed. The fibroblasts in keloids continue to multiply long after the wound has healed. Keloids protrude from the skin's surface, forming massive scar tissue mounds.

2. Name the Therapy Used in Keloid Skin Treatment.

Answer: Keloids can form when the skin is damaged by surgery, piercings, burns, chickenpox, or acne. The therapies used for keloid treatment are given below:

  • Corticosteroid shots

  • Cryotherapy 

  • Silicone sheets therapy

  • Laser therapy

  • Surgical method

  • Pressure treatment