About Keloids-The monstrous scars

 Keloids are fibrous lesions that form at a site of injury due to irregular production of type III and type I collagen. There is a difference between a keloid and a hypertrophic scar. Hypertrophic scars are confined to the extent of the wound or injury and may subside over a period of time. On the other hand, keloids may extend beyond the margin of the wound and may grow into neighbouring areas too.Unlike hypertrophic scars, keloids continue to grow outside of the original wound margins, fail to resolve over time, may itch and become painful. Keloids are generally associated with piercing on any part of the body.Although documented in all races, keloids are more prevalent in people of certain color (African American, Asian, Latinos) with a positive correlation to skin pigmentation. Most keloids appear in those with darker skin types while there are no reported incidents in Albinos. Keloids often mature into unsightly lesions affecting self-esteem and quality of life. Depending on the location and size of the keloid, range of motion may be impaired.

 Physical appearance of keloids

keloid scar on the ear

keloids may occur from head injury or razor bumps

 keloids develop most often on the chest, back, shoulders, and earlobes.Keloid typically starts to form within three months after the original skin damage although it can take up to a year Sometimes, a keloid can itch and even pain at touch causing a lot of discomfort. That is when you will need to seek a solution to remove the keloid and be at ease They are usually smooth, slightly shiny, firm skin growths. They can feel itch, and painful at touch. Once they have fully developed the pain usually disappears. 

 How Keloids form 

 In the formation of keloid, the first thing you will probably notice is that rubbery scar tissue starts growing beyond the borders of the original damage. It may become tender, itchy, and painful or produce a burning sensation. Sometimes keloid develops without any apparent skin injury, although most people can identify a cause. The common areas are the breastbone (sternum), shoulder, earlobe and cheek. Keloid growing over a joint can restrict movement. over time, the original red colour gradually changes to brown or becomes pale. Growth continues for a few weeks to a few months. The growth is usually slow but occasionally there is rapid enlargement over a few months. Once they stop growing most keloid scars remain the same size or shrink. Keloid scars are an overgrowth of skin after a cut or injury. Keloid scarring is an abnormal skin healing process , it bypasses normal replacement of worn out cell while the skin heals excessively. There may be a time lag of a month between the injury and the start of formation of keloid scar. Keloid scarring starts as a localised spot and forms progessively over months. Keloids can form in the following areas: Behind the ears after ear piercing. On the breastbone after chickenpox, acne, or an injury. On the side of the shoulder for example after a vaccine shots on deltoid. They can also occur after surgery, done by doctors - for example, after ear reduction surgery (where there is a scar behind the ears) or for removal of a suspicious skin growth. Anywhere on the body following injuries. 

 Causes of keloids 

There is limited knowledge regarding the causes of keloid scars. Science is still yet to be able to explain why some people go on to develop keloid scars after their skin is damaged, and others don't. However we do understand that keloid scars form because the normal process of scarring, that form normal healing process for everyone but goes overtly excessive: Normally when the skin is damaged, new skin comes up to replace the damaged ones which gradually wear out (this process is called 'involution'). In a keloid scar too much collagen is laid down in the skin after the damage has happened instead of the worn-out tissues scarring off and fading away, the scar tissue just stays where it is. Keloid scars are inexplicably common in people who have black skin and who originate from Africa or the Caribbean but probably due to higher melanin of their skin. It also happens to human being only;other animals do not get keloid scars. A skin tumour like a dermatofibroma or a soft tissue sarcoma can ocassionaly but rarely be mistaken for a keloid scar, or vice versa. 

 Preventing Keloid Formation 

For people with high risk of having keloids, it is beneficial they avoid piercings, tattoos and any unnecessary surgical procedures such as cosmetic surgery, especially in those areas of the body where keloid is prone to develop.If possible, such people should avoid surgery unless the benefits outweigh the risk. If you get acne, you should make sure it is treated effectively at an early stage so the spots do not scar. If you are identified as being at risk of keloid and need an operation, your surgeon may offer you dressings, steroid injections or other treatments to reduce the risk of keloid developing. 

Treatment Options for Keloids 

 Many patients often ask for their keloid scar to be 'cut out' or surgically removed. This is hardly ever successful and in fact can result in an even bigger keloid scar coming back. Keloids must never be cut out by a GP or by anyone who isn't medically qualified. They should only be treated by a specialist doctor such as a dermatologist or a plastic surgeon. Determining the most effective treatment for keloids has been challenging because how well a keloid scar responds to treatment can be unpredictable; many treatments are a matter of trial and error. There are several ways of treating keloid scars, without surgery:

 1. One of the most common methods is injecting steroids and local anaesthetic agent into the keloid scar itself. The injections are done with a tiny needle, but can be a bit sore. This method of drug administration is referred to as intralesional injection. The steroids and anaesthetic can help to stop the proliferation of the skin cells in the keloid scar. One such drug is Triamcinolone (Kenalog). Kenalog cream can applied externally to the keloid scar two times per day while the injection is administered intralesionally. Sometimes putting steroid ointment on, under a dressing, can dampen down a keloid scar. A tape that is impregnated with steroids is prescribed by dermatologists. They are helpful in children, who may not be able to tolerate steroid injections. 

Treatment Duration: Approximately one injection is given once a month, for 4-6 months. One of the side-effects of too many steroids in the skin can be that the skin gets thin and easily damaged. 

Some keloid scars are steroid resistant such that instead the steroid only causes serious side effects 

 2. silicone Treatment: Silicone is put on to the skin either as a gel or a flexible sheet. The efficacy of silicone in keloid treatment cannot be guaranteed but it has been claimed that it can reduce the thickness of the keloid scar and also makes the colour fade. The silicone gel is almost invisible once it's dry and is easy to apply. However, it can take a while to dry fully and you can't put any clothes on top until it's completely dry. 

 3. Laser therapy has been shown to be effective for keloid scars. These are specialised treatments used by specially trained dermatologists. You should not use a cosmetic skin clinic that does not have properly qualified doctors. 

 4. Superficial radiotherapy (SRT) treatment is another variant of options that is a making major advances in the treatment of keloids.It requires the work of a specialist. SRT treatment method targets those cells that overproduce scar tissue and result in the raised and expanded keloid scars that cause so much discomfort. The SRT–100 is an exciting new development and delivers superficial photon beam therapy to the healing scar. This controls the overproduction of collagen that leads to hypertrophic scarring. This is a superficial targeted treatment that does not penetrate beyond the fibroblasts responsible for wound healing. After excision the patient is given three consecutive doses of SRT over three days and the wound heals normally. 

 Below are some natural remedies to reduce keloid scars: 

 1. Lemon Juice – Extract the juice from a fresh lemon and apply it on the affected skin area. Leave it on the skin for about half an hour, and then wash the area with lukewarm water. Repeat the process at least once daily. 

 2. Baking Soda – Mix one part baking soda with three parts hydrogen peroxide to make a smooth paste. Apply the paste directly on the keloid scar to reduce inflammation and speed up the healing process. Do this three or four times a day depending upon the severity of the scar. 

 3. Aspirin – Crush three or four aspirin tablets and add a small amount of water to make a smooth, thick paste. Apply the paste on the scar, allow it to dry completely and then rinse it off by rubbing the area gently under water.Allow to dry and then apply some olive oil or tea tree oil. Repeat daily until the keloid is gone.

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