Keloid scars: causes, symptoms, diagnosis, treatment

The name keloid comes from the Greek word keleis - tumor and eidos-type, similarity. Keloids are divided into two groups - true or spontaneous and cicatricial or false. Spontaneous keloids or, so-called keloid disease is a disease manifested by the formation of keloids on the skin outside of the connection with trauma or inflammation. Sometimes they appear on the site of bruises or in places of pressure. This is an extremely rare disease, the etiology of which has not yet been established. MMZheltakov (1957) called such keloids primary (arisen without injury), AA Stadnitsin (1968) - spontaneous keloids. There are reports in the literature that say in some cases about autosomal dominant, in others - about autosomal recessive hereditary pathology of keloid disease. Propensity to keloid formation is also associated with immune pathology, hereditary predisposition, ethnic factors, age, endocrinopathies and violation of the regulatory functions of the central nervous system. Syndromes associated with keloids (Rubinstein-Taybi, Goeminne) are also described. There is also a large percentage of patients with keloid scars of representatives of black skin (inhabitants of South America, India, the Caribbean Islands), etc.

Patient K. A. 25 years. Has addressed with complaints on occurrence on a skin without the visible reason of firm formations of pink-red color. According to the patient, the first formation appeared on the spot of the acne element about 5 years ago. Later on, the formations appeared either on the site of inflammatory elements, or on perfectly healthy skin.

In a history of mild acne; dysmenorrhea, passed into amenorrhea. Autoimmune thyroiditis, euthyroid stage. The level of sexual hormones is within the normal range.

There was an attempt to surgically remove the keloid formation, where the keloid was several times larger than the previous one. The second keloid was taken for histological examination in the oncology institute. After the healing of the scar, a much larger keloid scar was again formed. The patient was assigned a laboratory examination, a consultation of an endocrinologist, a gynecologist. For a second appointment, she returned a year later. The clinical picture of scars during this time has significantly worsened. All scars increased in area.

Diagnosis: Keloid disease

Most often, the specialists encounter the second group of keloids, or with keloid scars.

What is a keloid scar? Why, in one case, does the wound quickly heal with the formation of a smooth and thin scar, and in other cases uncontrolled proliferation of coarctive connective tissue forming a pathological scar? Why, despite numerous modern studies, the severity of the problem of keloid scars does not decrease, but rather increases. This is evident from the increased patient appeal to doctors with keloid scars, the number of keloid complications after surgical interventions.

Symptoms of Keloid Scars

The clinic of keloid scars is characterized by a variety of manifestations of keloid growth. The general appearance of the scars depends on the area of injury, localization, type of initial injury, life expectancy, age of patients, etc. After the epithelialization of trauma or postoperative sutures against the background of the cessation of the inflammatory response, patients notice a tightening, which is often evaluated as a residual phenomenon after inflammation. Waiting for the natural process of resorption of the "infiltrate" is addressed to the doctor, when the seal is transformed into a dense, overlying skin surface or a formation with exophytic growth of considerable dimensions, a cartilaginous density of cyanotic red color. In some cases, keloid scars without previous inflammation occur 1 and 2 years after surgery, trauma or a puncture of the ear canal.

On smooth skin, keloid scars sometimes take on a whimsical shape, a completely different shape than the previous injury or inflammation focus. This is due to the spread of the keloid process along the lines of skin stretching (Langer lines). Sometimes a keloid scar, as it were, enters the healthy skin with elongated strands, according to the figurative expression of one of the researchers, with the "crab legs". Large keloid scars, for example after burns, often lead to the formation of scarring contractures.

It is important for physicians to know that between the healing of the wound and the appearance of the keloid scar there is a certain period of "rest", from 3-4 weeks to 2-3 months, when the patient notices the growth of scar tissue in all directions. However, such pathological growth of scar tissue can begin and after some time after trauma, a year and later on the site healed by primary tension of the wound or postoperative suture. The scar expands, especially along the lines of skin tension, becomes high, dense to the touch. In the people such scars were called "wild meat". This name very accurately characterizes the essence of keloids-the unmotivated proliferation of connective tissue at the site of the former trauma. The color of the scar in this case varies from bright red to cyanotic, the growth of the scar is often accompanied by paresthesia, painful sensations during palpation, contact with clothing. Itching in the scar area is noted by almost all patients. Young scars are distinguished by a very high density due to the synthesis by fibroblasts of water-tight molecules (glycosaminoglycans, collagen protein), old keloids also often have cartilage density, which is associated with the deposition of hyaline protein and calcium. In some cases, over time, keloid scars may turn pale, flatten and become soft upon palpation. However, quite often and in 10 years they look red, tight and dense to the touch.

Keloid scars have a favorite localization. So the face, neck, shoulder girdle, sternum area is referred to keloid-dangerous zones, that is, the zones, the most frequent occurrence of keloid scars. This is not accidental, as the above areas are characterized by an increased number of receptors for testosterone and TGF-beta on skin cells, and keloid scars are often accompanied by hyperandrogenemia and high levels of TGF-beta in the blood plasma. Below the lumbar region, keloid scars are rarely formed.

Keloid scars of the auricles occur at the site of postoperative sutures and puncture under the earrings and, as a rule, appear after a protracted inflammatory process 3-4 weeks after the puncture or operation. Inflammation is accompanied by serous-purulent discharge, erythema and pain sensations. However, there are cases of the appearance of keloid scars of the earlobes a few years after the period of absolute well-being and even without previous trauma. Last time there are multiple keloids of the auricles. This is due to the fashion for wearing several earrings in one ear. We observed a patient who had 10 small (2-3 mm in diameter) and 1 large keloid (6 mm in diameter) on 2 auricles. It happens that they reach a large size (with a plum), which is largely due to the lack of information about the possibility of pathological scarring in the puncture sites of ear lobes under the earrings.

[1], [2], [3], [4], [5], [6]