A Family Doctor's Tale - KELOID

DOC I HAVE A KELOID

Keloid ( A Simple Guide to Keloid)is an overgrowth of fibroplastic tissue which occurs in an area of injured skin.


Sometimes it may occur spontaneously.


Keloid usually occur in dark skin people than in white skin.


Keloid is more common in women than in men.


Keloid may occur after skin injury especially burns.



Keloid are dense fibrous tissue which forms scars as a result:


1.Skin injury -cuts and lacerations, even superficial abrasions

I had a cut on the skin of my hand  10 years ago after broken glass from my glass door flew into my skin. A keloid formed over the wound and I had to inject myself with steroid to flatten it and revert the skin to normal. The skin is now normal.


2.Burns - from injury to the skin

A Filipino maid had a scald on her forearm after being splashed accidentally with  hot water. After treatment she had a keloid which was growing. She consulted me and after a few steroid injections, the skin has revert to normal.


3.Chemical damage to the skin - cosmetics, sulphuric acid burns,


There was this teenage boy who had a tattoo removed from his shoulder area by a Chinese traditional doctor using chemicals.
After the removal of the tattoo, a keloid formed over the tattoo area. He had a few steroid injections before the keloid disappeared.



4.Infections of the skin -acne, abscess, ulcers

 Many adolescent boys and girls develop keloid after they tried to squeeze the pimples resulting in scar tissue and keloid formation. The keloid usually is small and 1 injection of steroid usually clear the keloid. Do not squeeze your pimples.



5.Surgery - incision scars after operations

Many patients with major operations of the abdomen and chest developed keloid formation from the scar. If the scar is large and the keloids fleshy and hard, a few weeks of steroid injections may be necessary to remove the keloids.


6.Postvaccination scarring such a keloid at BCG vaccination

Many school girls who had their BCG (against tuberculosis) injections on the shoulder developed keloids at the site of the injection. Rarely some of the keloids may disappear spontaneously while others grew bigger. These keloids can be injected with steroids to revert them to normal skin. 


Symptoms :


1.raised red fleshy looking irregular swelling of the skin at site of injury


2.smooth and shiny surface


3.Usually painless, may be itchy


4.Usually grow bigger



Signs:


1.swelling is red, fleshy looking with blood vessels present


2.irregular appearance with shiny smooth surface


3.May occur anywhere on the body


4.Swelling quite hard on palpation


Microscopic examination shows the presence of a fibroplastic cells with blood vessels and nerve endings.


The keloid can be irritated by shaving, clothing or jewellery.


Some keloids may have:


1. bleeding


2. infection especially in diabetes


The only treatment is removal of the keloid.


This can be done by :


1.Injection of corticosteroids into the base of keloids


2.Excision followed by corticosteroid injections.


3.Cryosurgery (freezing with liquid nitrogen)


4.Taping of keloid with pressure adhesive tape to prevent growth and flattening of keloids.


Some keloids may resolve spontaneously.

I have one patient whose keloid following BCG vaccination totally disappeared after her pregnancy and delivery of baby. May be it is the body which absorbed the fibroblastic tissues from the keloid.



The prognosis is usually excellent.


Recurrence at the same spot is common due to regrowth of the blood vessel supplying the keloid.