As the United States’ demographic profile diversifies, so do the health needs of its people. Dermatologists are striving to better understand skin disorders that are more common or unique in individuals with skin of color—including African Americans, Asians, Native Americans and Hispanics. Keloids are one such skin condition disproportionately affecting certain ethnic and minority groups.
What Are Keloids?
Keloids are benign growths that occur as a result of trauma or injury to the skin. They can appear after a surgical incision or emerge from something as minimal as acne.
These are firm, shiny, enlarged scars vary in color from pink to dark brown. They are most commonly located on the chest, shoulders, back, and earlobes, but can form anywhere on the body.
Keloids are more than a cosmetic concern; 80 percent of patients who have them report burning, itching, pain and tenderness at the involved site. Depending on where they’re located, keloids also can be associated with tightened scarring that can lead to severe functional impairment of the affected area.
Who Are Most Effected?
Keloids can occur in anyone but are observed more frequently in individuals of African, Hispanic and Asian descent. The condition represents a significant clinical problem, especially in black populations, in whichtheir incidence has been estimated at anywhere between four and 16 percent. Keloids are also diagnosed more frequently among young women. (This number may reflect the greater frequency of earlobe piercing in women.)
The diagnosis of keloids is straightforward and is usually made based on a physician’s visual inspection; however, keloids can be confused with hypertrophic scars, which are also raised, firm scars that occur at sites of trauma. But unlike keloids, hypertrophic scars do not extend beyond the boundary of the initial injury and can undergo partial regression over time.
Doctors do not fully understand why and how keloids form. Several factors appear to be at play, including genetics. There is strong evidence that, in the case of this condition, the appropriate physiological balance needed for a normal scar to develop has been disturbed. By investigating keloid formation and wound healing at the most basic cellular level, researchers hope to better understand the origins of this common clinical problem.
There is no cure for keloids, but there are numerous treatment options. Unfortunately, many of the available therapies result in only temporary improvement and are associated with high rates of recurrence. Consult your primary care provider or a dermatologist to find out which treatment option or combination of therapies is most suitable for you.
Treatment Options:
Intra-lesional corticosteroid injections are the most common treatment option because they reduce inflammation and prevent the formation of abnormal collagen. Triamcinolone, the most commonly used steroid compound, is injected directly into the keloid. However, results are not permanent; treatments are often needed every four to six weeks.
Surgical excision is rarely used alone because of the high rate of recurrence, meaning that the keloids reappear after surgery. Therefore, surgery is often combined with other treatment modalities. In addition to various cosmetic laser treatments, other treatment options include:
Cryotherapy
Cryotherapy involves applying extremely low-temperature cryogens, such as liquid nitrogen, to the skin. It’s believed to work by altering collagen synthesis and promoting normal wound healing. This method works best on smaller keloids.
Radiotherapy
Radiotherapy is often used in combination with surgery. Its use is controversial due to reports that it is linked to the development of cancer. However, most experts agree that the associated risk is extremely low.
Silicone Gel Sheeting
Silicone Gel Sheeting involves applying flexible adhesive sheets to a wound. This increases the temperature as well as water and oxygen concentrations in the wound—factors that promote healing. The sheets are applied directly to the affected area and are most successful when worn for 12 to 24 hours. The course of treatment can last up to 12 weeks.
Imiquimod
Imiquimod is a topical cream that stimulates the body’s immune system. It is often used as an adjunct to prevent recurrence after a surgical removal.
5-Fluorouracil (5FU) & Bleomycin
5-Fluorouracil (5FU) & Bleomycin were traditionally used to treat cancer but are effective for inhibiting keloid growth.