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Patient Story
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A large keloid (Figure 141-1A) has been present on the upper ear of this 14-year-old boy for more than 2 years, since he experienced trauma to this area. The keloid was excised in the office with local anesthetic and the defect sutured using 5-0 Prolene (Figure 141-1B). The cosmetic result was excellent and the patient was happy.

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FIGURE 141-1

A. A large keloid has been present on the upper ear of this 14-year-old boy for more than 2 years, since he experienced trauma to this area. B. The keloid was excised in the office with local anesthetic and the defect sutured using 5-0 Prolene. The cosmetic result was excellent. (Used with permission from Richard P. Usatine, MD.)

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Introduction
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Keloids are benign dermal fibroproliferative tumors that form in scar because of altered wound healing. They form as a result of overproduction of extracellular matrix and dermal fibroblasts that have a high mitotic rate.

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Synonyms
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Cheloid.

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Epidemiology
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  • Individuals with darker pigmentation are more likely to develop keloids. Sixteen percent of black persons reported having keloids in a random sampling.1

  • Men and women are generally affected equally except that keloids are more common in young adult women—probably secondary to a higher rate of piercing the ears (Figure 141-2).2

  • Highest incidence is in individuals ages 10 to 20 years.2,3

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FIGURE 141-2

A keloid on the earlobe that started from piercing the ear. (Used with permission from Richard P. Usatine, MD.)

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Etiology and Pathophysiology
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  • Keloids are dermal fibrotic lesions that are a variation of the normal wound-healing process in the spectrum of fibroproliferative disorders.

  • Keloids are more likely to develop in areas of the body that are subjected to high skin tension such as over the sternum.

  • These can occur even up to a year after the injury and will enlarge beyond the scar margin. Burns and other injuries can heal with a keloid in just one portion of the area injured.

  • Wounds subjected to prolonged inflammation (acne cysts) are more likely to develop keloids.

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Risk Factors3
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  • Darker skin pigmentation (African, Hispanic, or Asian ethnicity) (Figure 141-3).

  • A family history of keloids.

  • Wound healing by secondary intention.

  • Wounds subjected to prolonged inflammation.

  • Sites of repeated trauma.

  • Pregnancy.

  • Body piercings (Figure 141-4).

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FIGURE 141-3

Two keloids on the back of this young African American woman. (Used with permission from Richard P. Usatine, MD.)

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