Keloids

Of scars and pearls

When the inner mantle of a shell gets injured

The mollusk creates a pearl

When human is injured

It creates a scar or a keloid

Physical or Emotional

Of scars and pearls

Of pearls and scars

(A poem by Ulysses Cabinatan 1814)

I was just reflecting on keloids, when I saw Ulysses Cabinatan’s poem written in 1814. I then wondered, what they must have thought of keloids then.

Some seven years ago my son developed keloids at the nape of his neck, as a result of clipper injury. My worry had always been will they grow bigger. Then I started researching on appropriate treatment of keloids.

Wao! I discovered very conflicting treatment regimens for keloids. Are scars and keloids the same and can both words be used interchangeably?  Keloids, according to research, are smooth, shiny, slightly pink, often dome shaped proliferative growths of fibrous tissue that form over areas of injury or over surgical wounds. These growths can even result from acne. Sometimes keloids form without an injury.

Keloids scar simply means your skin has suffered a wound. There are tissues in your body called fibrous tissue. These tissues are also known as scar tissues, and they will form scars right over a wound.

Sometimes an excess in scarring tissue develops and causes a hard growth which results in severe scarring. This growth is referred to as keloid and can be a lot bigger than the original injury.

A keloid is a type of tumour, but it is not malignant.  They are considered chronic and most often will form right after surgery.

There are other causes for these tumours, including burns, piercing your ears, chicken pox, and injuries to your skin. Unfortunately, we blacks, Asians, Latinos and African Americans can be genetically prone to the forming of keloids tissues.

So, when my son developed keloids I started feeling the back of my neck. I looked at my elder brother’s nape, and tried to remember whether my father before he died, or in his younger days, as much as I could remember, had keloid, since there is a genetic pre-disposition to keloids. Fortunately none of us apart from my son had keloids.

Then I remembered that one of my cousins had keloid at the nape of his neck, while we were growing up. So, scientifically speaking, did keloid skip one generation?

In normal wound healing there is a balance between new tissue biosynthesis and tissue degradation. This is achieved through the processes of apoptosis (programmed cell death), and remodelling of Extra- cellular – Matrix (ECM).

During keloid formation, there is a prolonged inflammatory phase – due to immune cell infiltration into the scar tissue. This contributes to excess fibroblast activity and increased deposition  of ECM,  resulting in the tissue projecting beyond the original wound margin.

Keloid scars occur in about 10% of Nigerian population. It is unclear why some people develop keloid scars and others do not. However several factors increase the risk of developing them; example, as I mentioned earlier – African, Asian, Hispanic or Latino descent – the risk is 15 to 20%; keloid is also higher in these groups with darker skin tones.

Keloid occurs in ages between 10 and 30 years. Family history of keloid scars shows that about 1 in 3 people with keloids have a parent, sibling or child who also has keloids. There may also be a link, between sex hormones and keloid scars. Research suggests a higher incidence of keloid scarring during puberty and pregnancy. In women, keloid scars tend to shrink in size after menopause.

After your skin is injured, your cells try to, repair it by forming a scar – in some people, the scar tissue keeps forming long after the wound heals. This extra scar tissue causes the raised area on your skin that is called keloid.

Doctors still aren’t sure why some people’s skins scar this way. Many different types of skin injures can lead to a keloid. These include cuts, puncture wounds, surgical scars, severe acne, chicken pox, insect bites, injection sites, piercings and tattoos. 

•You are more likely to develop a keloid if  you are black, Latino or Asian.

•You are younger than 30 years of age.

•You are pregnant.

•You are a teenager going through puberty.

•You have a history of keloids in your family.

As I mentioned earlier, keloid scars tend to develop and grow slowly. It can take a few months, or even longer than a year for a keloid scar to appear. The proliferating scar may continue to grow and spread for weeks, months or years.  However, it is possible for a keloid scar to grow and spread very quickly. They range in size from small dots to large growths of 12 inches or more. They most commonly appear on the ears, face, neck, shoulders, upper back and chest.

Scars on the upper trunk tend to be the largest. Common keloid scar symptoms include pain, itching or tenderness. Large scars can also limit movement of the affected body part. Keloids may be red, pink or purple in colour. The scar is usually darker than a person’s normal skin tone. It may continue to darken with time and sun exposure.

   Keloids are raised skin surface that feels different from surrounding skin. The raised area is usually fixed in place, meaning you can’t move it. Larger keloids can restrict movement and may be soft, rubbery or hard in texture.

If you notice a scar developing abnormally, please consult your doctor.

While it does not pose a health risk, a keloid scar can adversely affect your self-esteem and quality of life.

Keloids will not go away on their own, but may respond to treatment. A referral to a dermatologist may be necessary to effectively manage the problem.

Medical complications in certain places like bends and joints or while taking treatment like steroids injections or external irritant applications or suffering from diabetes, neurological disorder etc. On getting a flare up, it might cause more pain and itching and can finally end in contractures and restriction of movement in the affected spots.

When the keloid is extensive example after burns or injures, keloids can limit the mobility of the body parts due to contractures of the skin and its tissues. In cases where the keloids are very large or disfiguring, they tend to affect the person emotionally.

A dermatologist can diagnose a keloid by physical examination. If a keloid looks like a worrisome skin growth, and you are frightened of it being a cancer growth, a dermatologist may perform a skin biopsy. This involves removing a small section that can be studied and examined under a microscope after staining (Histology), to rule out cancerous cells.  There is no single treatment for keloids, and most treatments do not give completely satisfying results. Two or more treatment may be combined.

If you decide to pursue treatment for a keloid scar, you will have the best results, if you start treatment soon after the keloid appears.

Keloids return in more than 45% of people, when they are removed surgically. Keloids are less likely to return if surgical removal is combined with treatments.

Dressing: Most wound covering made of silicon-gel-sheets, have been shown in studies. To sometimes reduce the size of keloids over time. This treatment is safe and painless.

Compression: This involves using a bandage or tape to apply continuous pressure 24 hours a day, for a period of six to 12 months. Such compression can cause keloid to become smaller.

For keloids that form at the site of an ear- piercing, a clip, known as “Zimmer splint, usually reduces keloid size by at least 50%; after one year of compression. Zimmer splints that resemble earring are available.

•Cryosurgery: This freezing treatment with liquid nitrogen is repeated every 20 to 30 days. It can cause a side effect of lightening the skin colour, which limits this treatment usefulness.    Radiation therapy:- this therapy is controversial, because, radiation increases the risk of cancer. Radiation treatments may reduce scar formation, if they are used soon after surgery, during the

•Laser therapy: This is an alternative to conventional surgery of keloid removal. There is no good evidence that keloids are less likely to return after laser therapy, than after surgery

•Fluorouracil injections: Injections into the keloids with the combination of the chemotherapy drug fluorouracil and triamcinolone have been used, when other measures have not been

•Micro needling: This treatment is sometimes known as collagen induction therapy. It works by using a special tool to create several, tiny injuries, within a scar – these injuries usually heal within 2 days and new collagen is formed inside the scar. Collagen is a protein that helps to give our skin strength and elasticity.

•Chemical peels: This treatment works by removing the outer layers of skin using high concentration of a glycolic or salicylic acid. In doing so, it reduces the discolouring that is associated with scaring. This treatment should only be carried out by a qualified Doctor.

If you tend to get keloids, it is best to avoid piercings, tattoos, or any surgery you do not need. Keloids can grow after these procedures. Always be medically guided.

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