Keloids are a type of scar formation which results in an overgrowth of granulation tissue. They differ from Hypertrophic Scars as they can continue to grow beyond the boundaries of the original scar, where hypertrophic scars do not. Keloids are not contagious, they are benign lesions and not considered pre -cancerous. They are typically firm, rubbery areas that vary in color, size, shape. Keloids usually do not cause problems- other than cosmetic, however, sometimes they can cause pain or itch.
Keloid scars are most common in the 10-20 year age group. However, people of any age can develop keloids, but it is rare in children under the age of 10 years old. Family history of keloids is common as well; about 33% of people who get keloids have a first degree relative who also has them.
Keloids are also more common in people with darker skin tones, they are 15 times higher in pigmented populations.
Keloids affect both sexes equally.
Keloids can appear and grow over time and can appear acting almost like a tumor. No gene has been identified as a cause of keloid scarring
PATHOLOGY
Keloids form within scar tissue. They are fibrous growths characterized by a collection of atypical fibroblasts; excessive collection of collagen, elastin, and proteoglycans. Thick collagen accumulations form nodule like areas that extend into the dermis. The overgrowth of the granulation tissue continues until it is replaced by all collagen type one.
Keloids can occur at any area of tissue repair or damage. Ear lobes are very common due to piercing. Other common sites include burns, acne scars, chickenpox scars, surgical scars and vaccinations. Although rare, there have been reported cases of spontaneous eruptions
TREATMENTS
Treatments of Keloids are multiple and varied. The age of the patient is important in dictating the treatment modality, as well as the age of the lesions, and the desired outcomes.
The best treatment is prevention ,when possible, early treatment in tissue trauma should be instituted as soon after injury as possible if the patient has a history of keloids.
Surgery
The most common treatment for significant bulk of keloids
Large recurrence when used alone between 70-100%
Injections
- Corticosteroids- used to decrease fibroblastic activity thus shrinking the scar formation, 50-80% will shrink however most will regrow within 5 years
- Anti-Metabolites- 5-Flurorouracil-anti-cancer drug to stop the growth
- Interferon-Used to decrease synthesis of collagen and increasing collagenase activity
Cryotherapy
This treatment freezes the keloid. It spares the skin under the keloid and is used to reduce size. Works best on small areas.
Pressure Dressing
Used after keloid remove(surgery) to reduce blood flow. Most be worn for a long time and often painful
Laser
Used to reduce the height and color. Often used in combination with other modalities
Radiation
Used alone or after surgery to prevent reoccurrence or to reduce size of the lesion
Silicone sheets
Must be applied and commonly used with pressure. Success seen in flattening the lesion
Ligature
Surgical suture tied around the lesion to inhibit blood supply
Most of the above treatments are not used solely but in varied combinations.
Platelet-Rich-Plasma Treatment of Keloids
Platelet-Rich-Plasma is an autologous blood derived product that contains super physiologic concentrations of platelets. The concentration is rich in cytokines and growth factors needed for tissue repair and regeneration.
Platelet-Rich-Plasma has been proven to aid and repair scar formation and has been used to advance keloid treatment.
(Advancing Keloid Treatment: A Novel Multimodal Approach to Ear Keloids
Dermatol Surg. 2017 Sep;43(9) : 1164-1169 PMID 28375976)
The objective was the management of keloids of the pinna due to ear piercing.
Conclusion: Surgical excision combined with intraoperative PRP, adjuvant postoperative in office superficial radiation achieved a 94% nonrecurrence rate on a 2 year follow up. Strong evidence to support multimodal method as a viable alternative in the management of keloids in this area
Combined intralesional triamcinolone acetonide and platelet rich plasma versus intralesional Triamcinolone alone in the treatment of keloids
(Dermatolog Treat 2020 Mar 4;1-7 PMID 32063079)
40 patients with keloids were divided into 2 groups one treated with intralesional triamcinolone alone and the other with PRP plus triamcinolone
Conclusion: Combining intralesional PRP with TA yielded better outcomes cosmetically with a lower incidence of side effects especially atrophy and hypopigmentation
Triple treatment in ear keloids: Comparison of post-excisional intralesional steroid and platelet-rich-plasma treatment
(Am J Otolaryn May-Jun 2021;42(3) : 102935. PMID 33545451)
5 year follow up study of 60 patients. Patients were in 3 groups; only intralesional steroids, patients who had surgical excision and steroid shots preoperative and postoperative and third group had PRP with steroids and surgical excision
Conclusion: The combination of surgical excision with intralesional steroid and PRP treatment in patients with ear keloids should be considered highly successful multimodal treatment in terms of low recurrence and adverse effects
(Assessment of various intralesional injections in keloid: Comparative analysis Journal of Dermatological Treatment 2021 DOI: 10.1080/09546634.2021. 1914307)
Aim of this study is the comparison of intralesional treatments in keloids. Comparison was made between triamcinolone, 5-fluorouracil, verapamil and platelet rich plasma.
160 patients with 40 in each treatment group
Conclusion: This study demonstrates that keloid can be treated with intralesional steroid injection, verapamil, 5-FU and PRP. With the best results achieved with Platelet-Rich-Plasma that also has the advantages of better response on keloids, minimal side effects and low keloid recurrence.
Juventix Regenerative Medical manufactures a FDA approved Platelet Rich Plasma Kit that is cost effective, easy to use and provides reproducible outcomes from the same source.
Juventix Regenerative Medical also offers the NEW Juventix LED- Activator that activates the platelets without use of additives such as Calcium Chloride or Thrombin. Activation is an important step in releasing the substance required for repair and regeneration.
Juventix Regenerative Medical has a patented Bio-Incubator which transforms the Platelet Rich Plasma into a flowable Platelet Rich Fibrin Matrix for injection. Although not discussed in this article, Platelet Rich Fibrin has a proven record in wound repair and tissue regeneration.
Restore, Revive, Regenerate Juventix Regenerative Medical
Regenerative Regards,
Dr. Robert McGrath
