Core Dermatology Diagnoses / CategoriesNeoplastic Benign and Malignant

Keloid

Author: Faculty Reviewer:

Publish date: Posted on
Last updated: May 12, 2022

Keywords #

keloid
scarring
fibrosis
collagen

Diagnosis #

A keloid is a benign fibroproliferative tumor that is a result of dermal injury inciting the overproduction of collagen within the skin. [1,2] This benign growth extends beyond the original boundaries of the wound and can develop from any minor injury to the skin, including trauma and inflammation. Keloids progressively enlarge over time and do not spontaneously regress. [3]

Key Concepts #
  • Keloids extend beyond the original wound.
  • Keloids are benign and do not transform into skin cancer.
  • They may be asymptomatic, but are often painful and pruritic.
  • Those with darker skin types tend to form keloids more often than those with lighter skin types.
  • Keloids may cause functional impairment and disfigurement in patients, impacting their quality of life.[4]
Epidemiology #

The data on keloid epidemiology is limited, but the risk of developing keloids is 15 times higher in those with darker skin types than the risk of developing keloids in those with lighter skin types.[1] Although the incidence and prevalence of keloids are unknown, it has been reported that keloids can be present in 5-16% of Hispanic and African individuals.[1] Keloids are more common in younger individuals and may have a genetic predisposition with studies illustrating an autosomal dominant inheritance with incomplete penetrance. [5]

Clinical Features #
  • Keloids present as dermal tumors predominantly on the upper chest, back, shoulders, and head and neck regions, specifically the ear lobe.
  • Pain and pruritus are common.
Differential Diagnoses #
  • Hypertrophic scar
  • Nodular scleroderma
  • Dermatofibrosarcoma protuberans
  • Giant cell fibroblastoma
  • Lobomycosis
Diagnostic Workup #

A diagnostic workup is not indicated for a keloid as it is diagnosed clinically. However, a biopsy may be performed to rule out other entities on the differential diagnosis.

Treatment #
A keloid is a dermatologic condition that may be treated if symptomatic to a patient, however, the efficacy of treatment options continues to be inadequate. The most common
treatment utilized is intralesional corticosteroids, using triamcinolone acetonide 10 to 40 mg/mL, which may be effective in softening and flattening the scar. Multiple injections over weeks/months are often necessary, and subcutaneous atrophy may result. Other therapy options include intralesional fluorouracil, silicone gel sheets, pressure therapy, and cryotherapy for those refractory to initial steroid injection treatments. If conservative medical therapies are unsuccessful, surgical excision can also be considered, however recurrence of keloids can continue to be high for these patients. Radiation therapy can also be utilized as another option for patients either as monotherapy or post-surgically after the excision is performed. Laser therapy may also be considered.
References #
  1. Robles DT, Berg D.Abnormal wound healing: keloids. Clin Dermatol.2007;25(1):26-32.
  2. Nemeth AJ. Keloids and hypertrophic scars. J Dermatol Surg Oncol. 1993;19(8): 738.
  3. Mahdavian DB, van der Veer WM, Ferreira JA, NiessenFB. Formation of hypertrophic scars: evolution and susceptibility. J Plast Surg Hand Surg. 2012;46(2): 95-101.
  4. Bock O, Schmid-Ott G, Malewski P, Mrowietz U. Quality of life of patients with keloid and hypertrophic scarring. Arch Dermatol Res. 2006;297(10): 433-438.
  5. Brown JJ, Bayat A. Genetic susceptibility to raised dermal scarring. Br J Dermatol. 2009;161(1): 8-18.
  6. Ogawa R, Akaishi S, Hyakusoku H. Differential and exclusive diagnosis of diseases that resemble keloids and hypertrophic scars. Ann Plast Surg. 2009;62(6): 660-664.
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