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| Fig. 62.8 Multiple keloids secondary to ear piercing. |
Keloids are benign dermal neoplasms composed of broad collagen bundles (Fig. 62-8). It is believed they represent an aberrant healing process. In distinction from hypertrophic scars, keloids extend beyond the bounds of the original wound. There exists a distinct tendency toward keloid formation in persons of color. Sites of predilection include the shoulders, mandible, earlobes, presternal area, and deltoid region. Any form of trauma can induce keloids, including thermal injuries, insect bites, acne scars, injection sites, or cosmetic piercings and surgical incisions. Keloids may occur spontaneously, particularly in the central chest area. It is quite possible that such a “spontaneous” keloid represents a reaction to unrecognized trauma. The causal abnormality in the normal healing process is not known with certainty. It appears, however, that genetically predisposed fibroblasts are stimulated to produce abnormally high levels of procollagen messenger RNA, leading to excessive collagen production and secretion. Treatment options have included radiation or pressure therapy, cryotherapy, intralesional corticosteroids or verapamil, interferon, fluorouracil, topical silicone dressings, and laser treatment (either pulsed dye or Nd:YAG). Surgical excision is typically followed by recurrence unless adjunct preventive therapies are employed.
Kelly AP: Update on the management of keloids,
Semin Cutan Med Surg 28:71–76, 2009.
