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Patient Story

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.

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.)

Introduction

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.

Synonyms

Cheloid.

Epidemiology

  • 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

FIGURE 141-2

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

Etiology and Pathophysiology

  • 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.

Risk Factors3

  • 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).

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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