How to deal with keloids?

Keloids, also known as connective tissue hyperplasia, is a pathological scar tissue that is secondary to skin trauma or spontaneously formed and shows excessive growth. The scar is higher than the skin surface, is hard and tough, and appears in nodular, cord-like or flaky form.

What are the characteristics of keloids?

These are obviously protruding from the surface of the skin, are red and shiny, have a smooth surface, tight skin, and often have dilated capillaries; they extend outward beyond the original site of injury, shaped like crab feet; and have a tough or even hard texture, with poor elasticity.

Patients often feel itchy or tingling, and feel pain when clothing touches lightly. These are most likely to occur on the chest, back, ears, and joints. Keloids are not only abnormal in color, which is very different from normal skin color, but also have strange shapes and are prominent. Among the four types of scars, they are the most unsightly.

If it occurs in the joints, it may affect the joint’s mobility. At the same time, it will also cause varying degrees of pain and itching, which will have a certain impact on the patient’s quality of life. If it occurs in the ears and other parts, it will affect the patient’s normal social life.

What are the types of keloids?

(1) Classification based on pathogenesis

Tumor-type keloids: usually appear as inconspicuously hyperemic, dark-colored, and obviously raised masses, similar to tumors.

Inflammatory keloid: The main clinical feature is usually obvious congestion accompanied by pain and itching.

(2) Classification based on scar size

Small keloid: diameter <2.0 cm

Medium and large keloids: scar length is 2.0 to 10.0 cm and width is less than 5.0 cm.

Extra large keloid: length > 10.0 cm, width ≥ 5.0 cm

What are the causes of keloids?

It often develops spontaneously, but can also be triggered by a variety of factors, including trauma and postoperative complications. Its onset is related to race, gender, age, and autosomal dominant genes. High-risk factors include: family history, dark skin, burns, and any factors that prolong wound healing.

How to treat keloids?

The treatment of keloids is difficult, mainly including surgery, drugs, radiation and other physical therapies. Different types of keloids have different treatment principles, and doctors will make reasonable judgments based on the situation.

•Treatment of tumor scars

(1) In principle, conservative treatment is recommended for small keloids, but surgical excision is still recommended for small keloids on the ears and those prone to local infection. After surgery, additional measures to prevent scarring may be needed depending on the situation.

(2) For medium and large keloids, a comprehensive treatment plan with surgery as the main treatment should be adopted as soon as possible, provided that measures have been taken to prevent the recurrence it after surgery.

(3) For extra-large tumor-type keloids, a comprehensive treatment plan of surgical excision supplemented with skin graft and flap repair should be adopted if the patient’s general condition permits and measures to prevent postoperative recurrence have been taken.

•Inflammatory scar treatment

1. Small keloids are still treated non-surgically. However, for medium, large or extra-large keloids, surgical treatment is still recommended in principle when conditions permit.
2. If medium or large inflammatory keloids have no obvious scar hyperplasia, but are mainly characterized by obvious congestion and flat soft tissue, non-surgical treatment can also be considered, including drug injection, redness-removing laser, silicone preparations and topical medications. If it is ineffective, surgical treatment should be considered.

For a more difficult surgery like keloid surgery, the selection of incisions and the rational use of flap techniques are the keys to ensuring postoperative beauty and all of them must be carefully considered. These require the doctor’s professional knowledge and practical skills.