About Keloid Scar
Keloid scar is a scar that extends beyond the original wound and invades nearby tissue due to excessive production of collagen and other extracellular matrix components. The exact pathophysiology of keloid formation is not fully understood, but several factors have been identified as potential causes:
- Abnormal proliferation of fibroblasts: Keloids are characterized by an increase in fibroblast proliferation, leading to excessive collagen production.
- Altered growth factor signaling: Dysregulation of growth factors, such as transforming growth factor-beta (TGF-β), plays a role in keloid formation by promoting fibroblast activation and collagen synthesis.
- Impaired collagen turnover: Keloids exhibit impaired collagen degradation, resulting in the accumulation of excessive collagen in the scar tissue.
- Genetic factors: Certain genetic variations have been associated with an increased risk of keloid formation, including variations in genes involved in collagen synthesis and inflammation.
Non-modifiable risk factors of keloid scar:
- Ethnicity: People with darker skin tones, particularly individuals of African, Asian, or Hispanic descent, are more prone to developing keloids.
- Family history: Having a family history of keloids increases the likelihood of developing them.
Modifiable risk factors of keloid scar:
- Wound tension: High tension on a wound during healing can increase the risk of keloid formation. Proper wound closure techniques and minimizing tension can help reduce this risk.
- Infection: Infections at the site of a wound can contribute to keloid formation. Prompt treatment and prevention of wound infections are important.
- Trauma or injury: Keloids often occur after traumatic injuries or surgical procedures. Taking precautions to minimize trauma to the skin during procedures may help reduce the risk.
It's important to note that these risk factors do not guarantee the development of keloids, and individual responses may vary. If you are concerned about keloid formation, it is recommended to consult with a healthcare professional for personalized advice.
Common symptoms of a keloid scar include:
- Raised scar that is pink, red, or purple.
- Round or oval shape.
- Pain and itching.
- Doughy or firm and rubbery texture.
As the keloid scar progresses, other symptoms may include:
- Extension beyond the original injured area
- Change in color to pink, purple, or brown.
- Interference with joint function if located over a joint.
- Unsightly appearance.
It's important to note that keloid scars can vary in their appearance and symptoms depending on the location and individual. If you suspect you have a keloid scar or are experiencing any concerning symptoms, it's best to consult with a healthcare professional for an accurate diagnosis and appropriate management.
To diagnose a keloid scar, the following examinations, tests, and procedures may be performed:
- Medical history and visual inspection: A doctor examines the appearance of the scar and gathers information about past tissue injury, such as surgery, acne, or body piercing.
- Palpation: The doctor may also feel the scar to assess its texture and thickness.
- Biopsy: In some cases, a small piece of the skin may be removed for examination under a microscope. This is called a biopsy and helps confirm the diagnosis.
Additional examinations and tests may be performed, including:
- Ultrasonic elastography: This non-invasive imaging test measures the hardness and physical properties of the scar. It can help differentiate keloids from surrounding tissues and evaluate treatment effectiveness over time.
- Observer assessments: Physicians may use standardized assessment tools like the Vancouver Scar Scale (VSS) or Patient and Observer Scar Assessment Scale (POSAS) to evaluate the scar's appearance and severity.
Remember that these examinations, tests, and procedures should be performed by healthcare professionals. It's important to consult with your doctor for personalized advice on diagnosing and assessing the severity of a keloid scar.
The goals of treatment for keloid scar are to reduce inflammation, improve the cosmetic appearance of the scar, and prevent recurrence. Here are the different types of treatments and how they work towards achieving these goals:
Medications:
- Steroid Injections: These injections reduce inflammation and decrease fibroblast proliferation and collagen synthesis in the scar tissue.
- Steroid Creams or Tapes: These topical medications also help reduce inflammation in the scar.
- Adrenocortical Hormone Agents: These can be administered via tape/plaster or by injection to improve the height and stiffness of keloids and hypertrophic scars.
Therapies:
- Cryotherapy: Freezing off a keloid scar can induce vascular damage and scar tissue necrosis, reducing its size.
- Laser and Light Therapy: This therapy, often combined with steroid injections, can help improve the appearance of keloids.
- Psychosocial Support: Specialist psychological help can assist patients in accepting their altered appearance and dealing with the trauma caused by the scar-inducing event.
Therapeutic Procedures:
- Surgical Revision or Excision: This traditional treatment aims to reduce skin tension by removing the scar tissue. However, recurrence rates, especially for keloids, can be high.
- Combination Therapy: Postoperative steroid application can be used alongside surgical revision to improve outcomes.
It's important to note that each treatment option has its own benefits and limitations. Consult with a dermatologist to determine the most suitable approach for your individual situation. Medication dosing may be affected by many factors, so it's crucial to check with your healthcare professional for personalized dosing information. Side effects can occur, so consult your healthcare professional or read the information provided with your medication for side effect information.