A keloid is the term given to the prominent, irregular scar tissue, which sometimes forms after a person has suffered a small cut or a scratch in the skin. Usually, a “bump” appears at the site of the injury. The bump becomes larger and over time a full-blown (and often unsightly) keloid develops. It is important to point out that sometimes keloids develop spontaneously, without injury to the skin.
The cause of keloids is genetic and we are unlikely to be able to prevent keloids until gene therapy develops in this century. Now there exists in the US and Paris a research project to map out every gene in the human body. This project, known as the Human Genome Project, will hopefully identify the gene that codes for keloids. Once found, we would have the potential to turn off the gene responsible for keloid formation!
Blacks and Keloids
Most often, keloids are found in people of African descent. I have also seen keloids in Indians and Chinese, and more rarely in Whites. Keloids tend to run in families. If your parents or siblings have keloids, you are more likely to have them as well.
Keloids have been noted in Africans throughout history. One of the theories that has been postulated for the predominance of keloids in Blacks is the fact that when keloids are developed they become insensitive to pain. In Africa, men would put scars on their bodies in order to develop keloids. The keloids would then become a sort of natural armor, giving some protection. This “scarification” of the body would also take place at particular times of the year, in accordance with local customs. Most of this knowledge is historically interesting and has been lost to us in the west!
Prevention of Keloids
One of the most important things that one can do to prevent the formation of keloids is to properly care for skin abrasions and cuts. It is important to remember that any cut that is deep enough to require stitches (sutures) should be stitched promptly. Many people will put a dressing over the cut and allow it to remain open. In these cases, a keloid is likely to develop and/or the site if injury will become infected. It is important for doctors to carefully suture the wound and to avoid damage to the surrounding skin in the suturing process.
Keloids are never life threatening. Rather, they are cosmetic and cosmetic only. One’s appearance is important, however, and keloids are problematic from this perspective.
The treatment of keloids will vary. Some people believe that if the keloid is cut out all will be well. Many times, however, the keloid will return larger than it was before. Doctors have, therefore, developed several ways to treat keloids:
1. Injection of the keloid with steroid solutions. Steroids have the effect of causing tissues to become atrophic (thin). This is a known side effect of steroids that we are using to our advantage when we inject the keloids with the steroid solution.
2. Surgery of the keloid with use of steroid injections. In this case, we still inject the keloid for several weeks prior to the surgery. Then, we surgically remove the keloid material and the wound is carefully sutured. Steroids are again injected and continued for several weeks thereafter.
3. Surgery of the keloid followed by radiation therapy. In this case, patients receive superficial radiation to the affected area. This may be a good option in some cases.
4. Lately, there has been the development of pressure to treat keloids. Scientists have developed a type of sheeting called silastic gel which is applied to the keloid and kept in place with tape. The silastic gel is applied at night for several months and it flattens the keloid.
5. Additionally, a newer therapy involving tape impregnated with steroids has been used. The tape is applied to the keloid and the steroid is slowly released. Overtime, the keloid thins.
Keloids are very common in Black people throughout the world.
Keloids usually occur after a person has suffered a cut or scratch to the skin.
The resulting scar tissue is thickened and often unsightly.
There are a variety of treatment options available and your dermatologist will be happy to discuss them with you.
Treating keloids can be challenging, but good results can be obtained!