English
German
French
Italian
Spanish
Portuguese
Chinese
Lithuanian
EE60
3.2.4 Keloid
Grading & Level of Importance: C
ICD-11
Synonyms
Cheloid, Cicatrix keloidalis.
Epidemiology
Higher incidence in dark-pigmented populations, during puberty and pregnancy and in positive family history.
Definition
Benign scar tissue which grows beyond the borders of the original injury or surgical defect.
Aetiology & Pathogenesis
Aberrant wound healing of surgical wounds, injuries (piercings, tattooing, scarification, insect bites, vaccinations), burns, skin-damaging infections, acne, increased skin tension, spontaneous (no trigger found). Overproduction of collagen I and III (20x greater than that of healthy skin and 3x greater than a hypertrophic scar).
Signs & Symptoms
Bizarre sharply bordered nodular proliferation of connective tissue with erythema, pruritus and sometimes pain. Keloid extends beyond original defect.
Localisation
Predilection sites: presternal, neck, shoulders, tense wounds, joints.
Classification
No international classification exists, clinically: suppurative keloid, presternal keloid, juxta-articular keloid, folliculitis keloidalis nuchae.
Dermatopathology
Increased whorls of thickened, hyalinized collagen bundles of the dermis.
Course
Keloids may develop 1 to 12 months after injury. Do not improve with time or heal spontaneously.
Complications
Contractures over joints hamper motion, chronic itching/pain.
Diagnosis
History, clinical features.
Differential diagnosis
Hypertrophic scar (remains confined to area of surgery or damage), sarcoidosis, dermatofibroma, dermatofibrosarcoma.
Prevention & Therapy
Prevention is essential, cosmetic and elective surgical procedures should be performed considering the development of keloids. Rapid primary closure, adequate hemostasis, reduction of wound tension, compression therapy may reduce keloid development.
Intralesional corticosteroids mostly in combination with contact cryosurgery, intralesional cryosurgery, surgical excision with post-surgical radiation or intralesional steroids, radiotherapy, LASER treatment can be considered. Topical imiquimod, intralesional botulinum toxin, intralesional bleomycin or 5-fluorouracil, silicone gel tapes.
It is important to manage patient expectations.
Differential Diagnosis
Podcasts
Tests
- A keloid should not be biopsied because…
- Which of these statements about keloids are true?
- What are the therapy possibilities for a keloid?
- Keloids can appear on the whole Integument, the most commeon regions are
- Statement 1: Keloids can be treated with excision and tension-free closure
- A keloid should not be biopsied because
- Which of these statements about keloids are true?
- What are the therapy possibilities for a keloid?
- Statement 1 This lesion is most likely a keloid
- Statement 1 Keloids can be treated with excision and tension-free closure
Comments
Be the first one to leave a comment!