Keloids

What are keloids?

Keloids are benign growths that occur as a result of trauma and injury to the skin. This trauma and injury can be in the form of a surgical incision or from something as minimal as acne.

Who is at risk for developing keloids?

Keloids can occur in anyone but are observed more frequently in individuals of African, Hispanic and Asian descent. Keloids represent a significant clinical problem, especially in black populations where the incidence of keloids has been estimated at 4-16%.

How would I know if I had a keloid?

Keloids are firm, shiny enlarged scars. They can vary from pink to dark brown in color. Keloids are most commonly located on the chest, shoulders, back, and earlobes.

What are the signs and symptoms of keloids?

Keloids are not only a cosmetic concern; 80 percent of patients report itching, pain and tenderness.

How are keloids diagnosed?

The diagnosis of keloids is fairly straight forward and is usually made based on physical exam findings by your doctor.

Do scientists know the cause of keloids?

Scientists do not fully understand why and how keloids form. Multiple factors appear to be at play. The fact that keloids can occur in multiple family members and their increased prevalence in certain races suggest that there is a genetic component to the development of keloids. There is also evidence to show that the appropriate balance needed for a normal scar to develop has been disturbed in keloids formation. By investigating the molecular mechanisms of keloids, researchers at the Hampton University Skin of Color Research Institute hope to develop a better understanding of the etiology of this common clinical problem.

Is there a cure for keloids?

Currently there is no cure for keloids, but there are numerous treatment options. Unfortunately, many of the available therapies result in temporary improvement and there is a high risk of recurrence. Some of the current available treatment options are listed below:

  • Intralesional steroid injections
  • Surgical excision
  • Cryotherapy
  • Radiotherapy
  • Laser treatments
  • Silicone gel sheeting
  • Imiquimod cream
  • 5-Fluorouracil: cream or injected formulation
  • Bleomycin
  • Interferon alpha-2b

 

Who should I see for the treatment and evaluation of keloids?

You can consult with your primary provider or a dermatologist to find out which treatment option is most suitable for you.

Treatment of Keloids and Scars

Dr. Brian Berman, MD, PhD
Department of Dermatology
University of Miami School of Medicine

New treatments using immune response modifiers and anti-fibrotics offer new hope to patients who suffer from keloid scars, according the Dr. Brian Berman in a presentation at the 2011 HUSCRI Skin of Color Symposium. Dr. Berman presented the results of studies involving several promising treatments that significantly lessen the formation of keloid scars and are well-tolerated by patients. "Additional trials," states Berman, " will advance these treatment strategies and make a real difference in the lives of millions of keloid patients."

The Pathological Stem Cell Niche Governs Keloid Growth

Dr. Anh Lee, DDS, PhD
Associate Professor
Oral and Maxillofacial Surgery
University of Southern California

Dr. Anh Lee and the research team at University of Southern California have made significant inroads in developing an animal model that will help in understanding of keloid formation and lead to new and better therapies. Speaking at the 2011 HUSCRI Skin of Color Symposium presented research into keloids and the stem cell niche that promotes keloid growth. Keloids, a tumor-like growth that extends beyond wound margins are a significant problem in wound healing, particularly among patients of African- American descent. Keloids are hard to treat since they often recur, and no single treatment appears to be affective. The lack of an animal model and clinical studies has been an obstacle to developing effective treatments. "Using stem cells that are precursors of keloids, we have been able to develop a human keloid-like tumor model", explains Dr. Lee. This model is significant in that it can be used to test the anti-tumor therapeutic effects of antibodies specifically targeting the keloid-related genetic niche, and could lead to new and effective treatments for keloids.

Ethnic Differences in Genetic Predisposition to Dermal Wound Healing Disorders and Keloid Formation

Ernst Reichenberger, Ph. D.
University of Connecticut Health System
Center for Regenerative Medicine and Skeletal Development

Keloid scarring is a disfiguring condition that can be precipitated by an injury to the skin or something as simple as acne. Keloids are more common in skin of color but the mechanism that leads to their formation is not well understood. Dr. Ernst Reichenberger speaking at the 2012 HUSCRI Skin of Color Symposium in Hampton Virginia summarized the current state of knowledge regarding keloids and their formation and a look forward to what is needed to diagnose and treat this disorder. "Keloids are a complex disorder, and more genetic studies are needed to understand the mechanism underlying keloid formation," stated Reichenberger. There are many things that are not understood including linkages with other disorders such as hypertension. Keloid formers are three times more likely to be hypertensive and about one-quarter of African Americans with hypertension form keloid scars. Additional studies are particularly valuable not only to better understand, diagnose and treat keloids, but because keloids are a useful model to study regulation of wound healing and organ regeneration as well as other fibrotic conditions of the skin.

Keloid Development Structure, Differential Diagnosis and Matrix Remodeling

Shirley Russell, Ph. D.
Center for Human Genetics Research
Division of Dermatology
Department of Medicine
Vanderbilt University School of Medicine

Keloid scars, which are benign tumor-like growths that grow beyond injury margins, are more prevalent and severe in individuals of African ancestry. As presented by Dr. Shirley Russell at the 2011 HUSCRI Skin of Color Symposium, keloids are one of many fibrotic disorders that could benefit from a better fundamental understanding of the process of fibrosis. Some research is being done regarding specific pathways to help understand fibrosis and wound healing, including keloid formation. Epigenetics, the study of how parts of the genome switch on and off at certain times can be a key to understanding fibrosis and the disorders it causes as well as providing effective treatments meeting this serious unmet medical need. "Further studies and understanding of these mechanisms", states Russell, "could be key to therapies for keloids and other fibrotic disorders that are more prevalent and severe in people of African ancestry."