Most keloids are round, oval, or oblong with regular margins; however, some have clawlike conFigureurations with irregular borders. Keloids overlying a joint can contract and restrict movement .
Treatment of keloids can be very difficult since they commonly recur—sometimes even larger in size than prior to removal. A keloidal scar is a thick dense, hard lump ranging from the size of a small sesame seed to that of a grapefruit, and expanding well beyond the area of the original injury or area of inflammation. Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals.
Keloids manifest as exaggerated growths of scar tissue, usually in areas of previous trauma. Keloids extend past the areas of trauma, projecting above the level of the surrounding skin, but they rarely extend into underlying subcutaneous tissue . Expression of connexins and other constituent proteins of gap junctions along with gap junctional intercellular communication are involved in cellular development and differentiation processes.
Keloids often have a lumpy surface and are often tender, itchy or inflamed around the growing border. 7-After surgery or injury, apply aseptic precautions and always keep the wound clean. 5-Female patients with wounds on the anterior chest should wear surgical bra and appropriate clothing to prevent increase in tensile strength by the weight of the breasts . Tacrolimus is an immunomodulator that inhibits TNF-alpha Gli -1, an oncogene, has been found to be overexpressed in fibroblasts of keloids. Inhibition of this oncogene may restore the natural apoptosis process and decrease proliferation of the ECM protein.
In a previous study, 11 patients used tacrolimus 0.1% ointment twice daily for 12 weeks on their keloids. Although the results were not statistically significant, the study showed a decrease in induration, tenderness, erythema, and pruritus for most patients . Tamoxifen, a synthetic nonsteroidal antiestrogen used to treat breast cancer, has been shown to inhibit proliferation of keloid fibroblasts and their collagen synthesis in monolayer cultures. A previous study demonstrated that tamoxifen exhibits dermal fibroblast in vitro. Tamoxifen has also been shown to reduce TGFalpha production by keloid fibroblasts in vitro.
It is a common cutaneous nodule of unknown etiology that occurs more often in women. Dermatofibroma frequently develops on the extremities and is usually asymptomatic, although pruritus and tenderness can be present. Removal of the tumor is usually not typically required unless diagnostic uncertainty exists or particularly troubling symptoms are present . Vary from 40% to 70% following surgery to up to 91% following burn injury, depending on the depth of the wound. Once they stop growing, keloids do not usually cause symptoms and remain stable or involute slightly .
Doxorubicin is a commonly used chemotherapeutic agent that irreversibly inactivates prolyl 4-hydroxylase in human skin fibroblasts and has been shown to inhibit collagen alpha-chain assembly. Another mechanism of doxorubicin-induced inhibition of collagen synthesis includes the inhibition of the enzyme prolidase, which is key in the process of collagen resynthesis . Decreased recurrence rates have been reported with excision in combination with other postoperative modalities, such as radiotherapy, injected IFN, or corticosteroid therapy. Excisional surgery alone has been shown to yield a % recurrence rate and should very rarely be used as a solitary modality, although excision in combination with adjunct measures can be curative.
Platelet-Derived Growth Factor is known to stimulate the proliferation of connective tissue. High expression of PDGFreceptor in fibroblasts derived from keloid, maybe contribute to the formation of keloid . Also, insulin-like growth factor-1 receptor (IGF-IR) may be involved in the pathogenesis of keloid . Although keloids are defined as a dermal disease involving fibroblasts, there is suggestion for keratinocyte involvements .
Keloids are nodular tumors range in consistency from soft and doughy to rubbery and hard, and have shiny and soft surfaces. Lesions are usually devoid of hair follicles and other functioning adnexal glands. In the Caucasian patient, keloids tend to be erythematous and telangiectatic; they are often hyperpigmented in darker-skinned individuals. Early lesions are often erythematous, then they become brownish red and then pale as they age.
Most lesions continue to grow for weeks to months and others grow for years. Growth is usually slow, but keloids occasionally enlarge rapidly, tripling in size within months. Keloids on the ears, neck, and abdomen tend to be pedunculated. Keloids on the central chest and extremities are usually raised with a flat surface, and the base is often wider than the top .
Most studies in which excisional surgery was combined with injected steroids reported a recurrence rate of less than 50%. Surgery followed by adjunctive radiotherapy has obtained recurrence rates of 0-8.6%. Different diagnosis between keloid and hypertrophic scar is not only a clinical challenge, but also histological challenge. We will review histological differences between keloid and hypertrophic scar for accurate diagnosis .
Sometimes putting steroid ointment on, under a dressing, can dampen down a keloid scar. A tape that is impregnated with steroids is prescribed by dermatologists. They are helpful in children, who may not be able to tolerate steroid injections. However, it can take a while to dry fully and you can’t put any clothes on top until it’s completely dry.