Dermatology - Keloids

Dermatology - Keloids 
Keloids and hypertrophic scars are excessive fibrous structures that form following a skin injury.
Keloids have protrusions that extend beyond the location of the initial damage, frequently resembling claw-like formations, whereas hypertrophic scars are limited to the original site of injury. Keloids can be aesthetically displeasing and present a significant challenge for patients when they are large and located on the ear, face, or near a joint. Keloids typically manifest in individuals during their third decade of life, however they can develop at any stage of adulthood. They exhibit a higher prevalence among those with darker skin tones and those with blood type A.
Keloids often do not cause any symptoms, however they may become itchy or unpleasant upon contact.

The lesions range from little papules to nodules to big tuberous lesions. Typically, they have a skin-colored appearance, however they can also be vivid red or bluish. They are characterized by their firm to hard texture and smooth surface. Following a traumatic or surgical injury, the resulting scars can exhibit a linear shape, while others may appear oval or spherical. Lesions are predominantly located on the earlobes, shoulders, upper back, and chest. Spontaneous keloids develop spontaneously without any external injury or surgical intervention, and typically manifest on the chest.

A clinical diagnosis is sufficient and a biopsy should only be considered if there is uncertainty in the clinical assessment, as it has the potential to produce further hypertrophic scarring. The differential diagnosis comprises dermatofibroma, dermatofibrosarcoma protuberans, desmoid tumor, scar with sarcoidosis, and foreign-body granuloma.

Managing the situation is difficult because there is no treatment that is significantly effective. Monthly administration of triamcinolone via intralesional injection (at a concentration of 10-40 mg/mL) can alleviate itchiness or sensitivity of the lesion, while also reducing its size and flattening it. It is important to note that this treatment is less effective for keloids compared to hypertrophic scars. Surgically removed lesions frequently have a bigger recurrence compared to the initial lesion. Surgical excision followed by rapid radiation yields favorable outcomes. Silicone creams and gels can provide advantages in the treatment of keloids, as they are both painless and noninvasive. Individuals with a predisposition to hypertrophic scars or keloids should be cautioned against undergoing cosmetic operations like ear piercing.