Keloid , also known as keloid disorder and keloidal scar , is the formation of a scar type which, depending on its maturity, is mainly composed of either type III early) or type I (late) collagen. This is the result of overgrowth of the granulation tissue (type 3 collagen) at the site of a healed skin injury that is slowly replaced by type 1 collagen. Keloids are strong, flexible or fibrous fibrous or fibrous nodules, and may vary from pink to color that person's skin or red to a dark brown color. The keloid lesion is benign and non-infectious, but is sometimes accompanied by intense itching, pain, and altered texture. In severe cases, it can affect the movement of the skin. Keloid marks are seen 15 times more frequently in people of sub-Saharan African descent than those of European descent.
Keloid should not be confused with hypertrophic scars, which elevate scars that do not grow beyond the original wound limit.
Video Keloid
Signs and symptoms
Keloid develops in growth like a claw over normal skin. They have the ability to hurt with pain like needles or itching, though the degree of sensation varies from person to person.
If keloid becomes infected, it can be a boil. Removing scars is one of the treatment options; however, this may lead to more severe consequences: the probability that the former surgery produced will also be a high keloid, usually greater than 50%. Laser treatments have also been used with varying degrees of success.
Keloid is formed in scar tissue. Collagen, used in wound repair, tends to overgrow in this area, sometimes producing lumps many times larger than the original scar. They can also range in colors from pink to red. Although they usually occur at the site of injury, keloids can also arise spontaneously. They can occur in piercings and even from something as simple as pimples or scratches. They can occur as a result of acne scar tissue or severe pox, infection in wound sites, recurrent trauma in an area, excessive skin tension during wound closure or foreign objects in wounds. Keloid can sometimes be sensitive to chlorine. Keloid marks can grow, if it appears at a younger age, because the body is still growing.
Location
Keloid can develop anywhere where skin trauma has occurred. They can be the result of acne, insect bites, scratches, burns, or other skin injuries. Keloid marks can develop after surgery. They are more common in some sites, such as central chest (from sternotomy), back and shoulders (usually due to acne), and ear lobe (from ear piercing). They can also occur in body piercings. The most common sites are the ears, arms, pelvic area, and above the collarbone.
Maps Keloid
Cause
Most types of skin injuries can cause scarring. These include burns, acne scars, chickenpox scars, ear piercings, scratches, surgical incision, and vaccination sites.
According to the National Biotechnology Information Center (USA), keloid scarring is common in young people between the ages of 10 and 20 years. Research shows that those with dark skin have a higher risk of keloid scarring as a result of skin trauma. They occur in 15 - 20% of individuals with sub-Saharan African, Asian or Latino ancestors, significantly less in those of a Caucasian background and no cases are reported in patients with albinism. Keloids tend to have a genetic component, which means a person is more likely to have keloids if one or both parents have it. However, no single gene has been identified as a contributing factor to keloid scarring, but some susceptibility loci have been found, especially on chromosome 15.
Genetics
Most people, especially sub-Saharan Africa and African Americans, have a positive family history of keloid disorder. The development of keloids among twins also gives credibility to the presence of genetic susceptibility to developing keloids. Marneros et al. (1) reporting four pairs of identical twins with keloids; Ramakrishnan et al. also described a pair of twins that develop keloids at the same time after vaccination. The case series has reported a severe clinical keloid form in individuals with a positive family history and black African ancestry.
Pathology
Histologically, keloids are fibrotic tumors characterized by a collection of atypical fibroblasts with excessive deposition of extracellular matrix components, especially collagen, fibronectin, elastin, and proteoglycans. Generally, they contain relatively acellular and thick centers, an abundant collection of collagen that forms nodules in the deep skin of the lesion. Keloids present therapeutic challenges that must be overcome, as these lesions can cause significant pain, pruritus (itching), and physical damage. They may not improve in appearance over time and may limit mobility if located above the joint.
Keloids affect both sexes alike, although the incidence in young female patients has been reported to be higher than in younger men, possibly reflecting greater frequency of ear piercing among women. The frequency of occurrence is 15 times higher in high pigmented people. People of African descent have increased the risk of a keloid event.
Treatment
The best treatment is prevention in patients with known predisposes. This includes preventing unnecessary trauma or surgery (including ear piercing, elective mole removal), whenever possible. Any skin problem in a predisposing individual (eg, acne, infection) should be treated as early as possible to minimize the area of ​​inflammation.
Treatment of keloid scar depending on age. Radiotherapy, anti-metabolite and corticoids will not be recommended for use in children, to avoid harmful side effects, such as growth disorders.
In adults, corticosteroids are combined with 5-FU and PDL in triple therapy, improving yield and reducing side effects.
Further prophylaxis and therapeutic strategies include pressure therapy, silicone gel gel, intra-lesional acetone triamcinolone (TAC), cryosurgery, radiation, laser therapy, IFN, 5-FU and surgical excision as well as many topical extracts and agents.
Current surgical excision is still the most common treatment for a large number of keloid lesions. However, when used as a single form of treatment there is a great recurrence rate between 70 and 100%. It has also been known to cause the formation of larger lesions in relapse. Although not always successful alone, excision surgery when combined with other therapies dramatically decreases the relapse rate. Examples of this therapy include but are not limited to radiation therapy, pressure therapy and laser ablation. Pressure therapy after excision surgery has shown promising results, especially in the keloid of the ear and earlobes. The mechanism of exactly how pressure therapy works is unknown today but many patients with scars and keloid lesions benefit from it.
If keloids occur, the most effective treatment is superficial external beam radiotherapy (SRT), which can achieve a cure rate of up to 90%.
In addition, intralesional injections with corticosteroids such as Kenalog seem to help reduce inflammation and pruritus.
Cryotherapy or cryosurgery is the application of cold extreme to treat keloids. This method of treatment is easy to do and has shown results with little chance of recurrence.
Epidemiology
People of all ages can develop keloids. Children under 10 are less likely to develop keloids, even from ear piercing. Keloids can also develop from Pseudofolliculitis barbae; continue to shave when a person has a razor lump will cause irritation to the lump, infection, and over time keloid will form. People with shaving bulges are advised to stop shaving in order for the skin to repair itself before doing any form of hair removal. The tendency to form keloids is speculated to be offspring. Keloid can tend to appear to grow over time without puncturing the skin, almost showing slow tumor growth; the reasons for this tendency are unknown.
Extensive burns, whether hot or radiologic, can cause an enormous keloid; this is very common in victims of fire bombing, and is a signature effect of the Hiroshima and Nagasaki atomic bombs.
The true incidence and prevalence of keloids in the United States is unknown. Indeed, there has never been a population study to assess the epidemiology of this disorder. In the 2001 publication, Marneros stated that "reporting the incidence of keloids in the general population ranged from 16% among adults in Zaire to the lowest 0.09% in the UK," quoted Bloom's 1956 publication of the keloid ancestry. But we know, from clinical observations that this disorder is more common among sub-Saharan Africa, African Americans and Asians with prevalence rates estimated to be unreliable and very wide ranging from 4.5-16%. Careful and scientific population and epidemiological research on this disorder is needed.
History
Keloid is described by Egyptian surgeons around 1700 BC, recorded in Smith's papyrus, on surgical techniques. Baron Jean-Louis Alibert (1768-1837) identified keloid as an entity in 1806. He called them cancroÃÆ'¯de , then changed the name to chÃÆ' Â © loÃÆ'¯de to avoid confusion with cancer. This word is derived from the Greek ????, chele , which means "nail", here in the sense of "crab claw", and the suffix -oid , meaning " as".
References
Further reading
- RoÃÆ'Ÿmann, Nico (2005). Beitrag zur Pathogenese des Keloids and Seine Beeinflussbarkeit durch Steroidinjektionen Contribution to the pathogenesis of keloids and their effects by steroid injections (PhD Thesis) (in German). OCLCÃ, 179740918
- Ogawa, Rei; Mitsuhashi, Kiyoshi; Hyakusoku, Hiko; Miyashita, Tuguhiro (2003). "Electron-Beam Post-Surgical Irradiation Therapy for Keloid and Hypertrophic Wound: Retrospective Study of 147 Cases Followed for Over 18 Months". Plastic Surgery and Reconstruction . 111 (2): 547-53; discussion 554-5. doi: 10.1097/01.PRS.0000040466.55214.35. PMID 12560675.
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Okada, Emi; Maruyama, Yu (2007). "Are Keloid and Hypertrophic Wound Caused by Fungal Infections?". Plastic Surgery and Reconstruction . 120 (3): 814-5. doi: 10.1097/01.prs.0000278813.23244.3f. PMID 17700144.
External links
Source of the article : Wikipedia
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