What are Keloids?
Keloids are a result of excessive formation of scar tissue at the site of injury. Although they usually occur after an injury, they are known to occur spontaneously in some patients as well. Keloids tend to occur more commonly at the site where skin overlies hard bony surfaces, most common site being the chest. Keloids are more common in dark individuals, especially the Africans. Keloids differ from hypertrophic scars which are limited to the site of the injury whereas keloids grow beyond the injury site with claw-like extensions. They are darker in color and tend to have symptoms like pain and itching.
Keloids cause distress to the patient:
Common conditions that lead to keloids include ear-piercing, acne scars and chicken pox. Histogically, keloids comprise of fibrous tissue consisting of abundant collagen bundles. Atypical fibroblasts produce excessive tissue resulting in keloid. Longstanding keloids can cause considerable amount of distress to patients due to pain.Sometimes, itching is associated with pain. On occasions, keloids can ulcerate or get secondarily infected.
Symptomatic keloids call for treatment.
The first line of treatment of keloids is an injection of a long-acting steroid deep into the keloid. Triamcinolone acetonide is used in the concentration of 20-40 mg/ml. after the first dose. A gap of three to four weeks is required for the second injection. Intrakeloidal injections can itself be quite painful and modifying the technique can prevent this. Triamcinolone can be diluted with lignocaine to reduce post-injection pain. However pain while giving the injection can be minimized by infiltration of local anesthesia to the keloidal area before injecting the steroid.
Keloids resistant to seroid injections can be treated by other methods:
Excision of keloid can give rise to a keoid which is bigger than the original keloid. Hence pre-operative, intra-operative and post-operative steroid injections have to be given in case the excision is planned. Another common procedure with reasonable amount of success is by cryotherapy followed by intraleloidal steroid injections. Silicone gel sheets applied with pressure has been used to treat keloids with variable success. Although silicone sheets reduced pain anrd itching, size of the keloids is little altered.
Success has been claimed with intralesional injections of bleomycin into the keloids after proper local anaesthesia. Combination of 5-flurouracil with triamcinolone injections are also quite helpful in keloid treatment. Radiation therapy has been found to be helpful in reducing the size of steroids. However risk of malignancy prevents its routine use.
Alfa-interfeons injections into keloids are also found to be of value in treating keloids. Puled dye laser reduces the size of keloids without injuring the tissue. Hence, chances of recurrences are less. Pulse dye laser probably acts by reducing the activity of fibroblasts.