Keloids: The Medical Challenge Of A Skin Condition

The human body has its own mechanism of healing . Whenever there is a cut, bruise, incision , acne formation, burn tear or some kind of deeper skin damage, the body responds by going into damage control mode called healing. The healing process triggers an over-production of collagen that makes up the tissue of our skin. The collagen helps build up the tissues around the wound. As the tissue is new, it leaves an indentation or a discoloration that may fade away with time. However, scar tissue formation may take different forms in different people. In many cases it converts into a dense fibrous growth which is termed as a keloid. It basically is an occurrence that is seen in place of the healing scar tissue. What make the scar tissue look prominent is the growth beyond the borders of the actual wound area. The enlarging of the scar tissue becomes more obvious when the keloid grows almost like a lump.

Identifying A Keloid:

A keloid is unlike any other scar formation having its own distinct features. Knowing the distinction will go along way in treating this rather conspicuous deformation of the skin tissue.

  • Generally a lump grows over the area as the scar tissue expands and invades the healthy tissues around the wound.
  • Keloids are hairless and much darker in colour than the usual skin tone of the person.
  • They feel hard and rubbery and maybe raised above the level of the skin like a protrusion.
  • Keloids do not fade away with time as in the case of other scars.
  • Red or purple in colour, they itch and sometimes may prove to be quite painful.
  • They may appear in any part of the body but more commonly on the shoulder, neck or head.

Susceptibility Factor

The occurrence of keloids are connected to scarring caused during surgery or even in minor cases of incision , scratches, acne scars, ear piercing, vaccination sites or traumatic wounds.

Though there is no conclusive evidence to prove it fully , there is however emperical evidence that keloids do occur more commonly in people with darker complexion. This obviates the conclusion that Afrians, African-Americans, Asians and the Hispanic are more susceptible to this form of scarring. Keloidosis or the repeated occurrence of keloids is seen in these racial groups far more than any other group.

The appearance of this form of scar tissue is itself bewildering . It may occur immediately after the scar heals or sometimes it suddenly occurs many days or even months after the complete healing process has taken place. The appearance is usually accompanied by a small inflammation of the area with the skin turning reddish in color which with progressive sun exposure may turn darker. This makes the case all the more complicated as darker the keloid, the more difficult its removal.

Reducing the appearance of keloids in cases where there is a genetic predisposition is almost impossible. The only manner in which they may be inhibited is by reducing the chance of injury or self -induced injuries such as piercings that people in the younger age-groups seem to be indulging in.

Treatment Possibilities

Most keloids do not disappear with time. They may flatten or change in colour but the disfigurement of the skin continues for very long, often remaining permanently. Though not a life threatening skin ailment it does cause embarrassment to many and psychological distress.

To avoid any further skin complication particularly in people who are regularly undergoing sun exposure, it’s is prudent to get a skin biopsy done to rule out the possibility of skin tumor occurrence which is in fact quite similar to the larger sized keloids.

Most people opt for keloid removal because of the psychological distress and also because of the discomfort that arises from the rubbing of fabric on the growth. Besides there is always the nagging fear that it may grow larger in size. In many cases the keloid can be large enough to affect physical movement by appearing in larger patches at the joints that may lead to loss of flexibility. But, in more cases than one, it is the cosmetic overtures that decides on people wanting the removal of keloids.

Treatment Procedures

Perhaps one of the most difficult of scar tissue conditions that can be treated but with out the assurance of complete healing. Depending on the size and extent of the scarring, the treatment has to be decided through a series of examinations to ensure the safety and the side effects of the procedure. Also it is the place of appearance and the size of the keloid that usually decides the line of treatment .

  • Laser- The pulse-dye laser, often an expensive procedure, not covered by insurancet requiringseveral sittings can be highly effective in cases of smaller keloids.
  • Surgery-It lays open the chance for the appearance of more keloids in case the scar has been treated through another incision or by compressing thereby cutting off the blood supply.
  • Compression dressing using silicon – Known to be beneficial yet with variation in its results, the technique requires the wearing of silicon gel sheet over the keloid for months together which turns out to be cumbersome. There is also no evidence of its success.
  • Cryotherapy-Freezing of newly forming keloids with liquid nitrogen injectables to arrest its growth is known to be effective.
  • Steroid injections or Steroidal Strips and Dressing – Most preferred are cortisone injections that are intralesional steroids meant to arrest the growth of the tissues. Also known to have least effect even though it does enter the blood stream in minimal quantities.
  • Flurouracil which is a chemotherapy agent is used for treating keloidal growth.
  • Radiation is also known to be relatively safer than many other procedures and perhaps the most common and the cheapest.

Most methods of keloid treatment provide partial removal and do not prevent future appearance of such tissue generation. There has been thus a growing interest in the field od alternative medicine to provide some answers .

Those hoping to avoid invasive and hugely expensive treatments that don’t promise complete cure do have the option of exploring alternative medical remedies provided by gurus of ‘ayurveda’ or herbal sciences, who study the dramatic effect some botanical extracts have on various forms of scar.

Jojoba oil mixed with mustard oil extracts and rose essential oils are a proven formula to soften and slowly remove the tough surface tissues of keloids. The other botanical extracts such as calendula oil, coconut oil, cocoa butter,aloe vera extracts and lavender essential oils, combined cleverly to suit the type of keloid and the skin specification , have provided relief from the itch and the physical discomfort, while working dually to reduce inflammation .

Many dermatologists also recommend usage of creams containing silicon, imiquimod, retinoic acid, tamoxifen and treatments with botulinum toxin or a combination of onion extract, hydrocortisone, Vitamin E and silicon, as an over- the -counter medication.

More than any other form of scar treatment, keloids need a back up of constant care and follow-up action. One needs to prepare patients for the the long term implications of the treatment method. Most treatments are two- pronged needing first the surgical removal of the scar followed by the prevention through steroidal formulas to prevent the formation of excessive collagen. In all , in case of a predisposition to keloids, one must try to remain injury-free and with the smallest first signs arrest its growth as suggested by an expert.