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 the so-called keloid disease is a disease that manifests itself in the formation of keloids on the skin without connection with trauma or inflammation. Sometimes they appear at the site of bruises or in places of pressure. This is an extremely rare disease, the etiology of which has not yet been established. M.M. Zheltakov (1957) called such keloids primary (arising without trauma), A.A. Studnitsyn (1968) - spontaneous keloids. There are reports in the literature that speak in some cases of autosomal dominant, in others - of autosomal recessive hereditary pathology of keloid disease. The tendency to keloid formation is also associated with immune pathology, hereditary predisposition, ethnic factors, age, endocrinopathies and disorders of the regulatory functions of the central nervous system. Syndromes associated with keloids have also been described (Rubinstein-Taybi, Goeminne). A large percentage of patients with keloid scars are representatives of dark-skinned races (residents of South America, India, the Caribbean islands), etc.

Patient K. A., 25 years old. Came with complaints about the appearance of hard pink-red formations on the skin without any apparent reason. According to the patient, the first formation appeared on the site of an acne element about 5 years ago. Subsequently, the formations appeared either on the site of inflammatory elements or on completely healthy skin.

History of mild acne; dysmenorrhea progressing to amenorrhea. Autoimmune thyroiditis, euthyroid stage. Sex hormone levels are within normal limits.

There was an attempt to surgically remove a keloid formation, in the place of which a keloid several times larger than the previous one grew. The second keloid was taken for histological examination at the oncology institute. After the scar healed, a significantly larger keloid scar formed again. The patient was prescribed a laboratory examination, consultation with an endocrinologist, and a gynecologist. She returned for a follow-up appointment a year later. The clinical picture of the scars had significantly worsened during this time. All the scars increased in area.

Diagnosis: Keloid disease

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

What is a keloid scar? Why does one case of rapid wound healing with the formation of a smooth and thin scar occur, while in other cases there is an uncontrolled growth of rough connective tissue, forming a pathological scar? Why, despite numerous modern studies, the severity of the problem of keloid scars does not decrease, but on the contrary increases. This is evident from the increased number of patients seeking medical help with keloid scars, from the number of keloid complications after surgical interventions.

Symptoms of Keloid Scars

The clinical picture of keloid scars is characterized by a variety of manifestations of keloid growth. The general appearance of scars depends on the area of the injury, localization, type of initial injury, duration of existence, age of patients, etc. After epithelialization of the injury or postoperative sutures against the background of the cessation of the inflammatory reaction, patients notice a compaction, which is often assessed as residual effects after inflammation. While waiting for the natural process of resorption of the "infiltrate", they consult a doctor when the compaction is transformed into a dense ridge protruding above the skin surface or a formation with exophytic growth of significant size, cartilaginous density of a bluish-red color. In some cases, keloid scars occur without prior inflammation 1 and 2 years after surgery, injury or puncture of the auricles.

On smooth skin, keloid scars sometimes acquire bizarre outlines, of a completely different shape than the previous injury or inflammation. This is due to the spread of the keloid process along the skin stretch lines (Langer's lines). Sometimes a keloid scar seems to enter healthy skin in elongated strands, as one researcher figuratively put it, "crab legs". Large keloid scars, such as those after burns, often lead to the formation of cicatricial contractures.

It is important for doctors to know that between the healing of the wound and the appearance of a 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 also begin some time after the injury, a year or later at the site of a wound or postoperative suture that has healed by primary intention. The scar expands, especially along the lines of skin tension, becomes high, dense to the touch. People call such scars "wild meat". This name very accurately characterizes the essence of keloids - unmotivated proliferation of connective tissue at the site of a former injury. The color of the scar varies from bright red to bluish, the growth of the scar is often accompanied by paresthesia, painful sensations during palpation, contact with clothing. Itching in the area of the scar is noted by almost all patients. Young scars are characterized by a very high density due to the synthesis of moisture-absorbing molecules (glycosaminoglycans, collagen protein) by fibroblasts; old keloids also often have a cartilaginous density, which is associated with the deposition of hyaline protein and calcium. In some cases, over time, keloid scars can become pale, flattened and soft to the touch. However, quite often, even after 10 years, they look red, tense and dense to the touch.

Keloid scars have a favorite localization. So the face, neck, shoulder girdle, sternum area are considered keloid-dangerous zones, that is, zones where keloid scars most often occur. This is no accident, since the above-mentioned 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 a high level of TGF-beta in the blood plasma. Keloid scars are rare below the lumbar region.

Keloid scars of the auricles occur at the site of postoperative sutures and punctures for earrings and, as a rule, appear after a protracted inflammatory process 3-4 weeks after the puncture or surgery. The inflammation is accompanied by serous-purulent discharge, erythema and pain. However, there are cases of keloid scars of the auricles appearing several years after a period of absolute well-being and even without a previous injury. Recently, multiple keloids of the auricles have been observed. 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 large sizes (plum-sized), which is largely due to the lack of information on the possibility of pathological scarring at the sites of earlobe punctures for earrings.

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