Keloid

During the last 3 months, scars had developed on the sternal area of a 25-year-old black woman. She recalls having punctured an acne pustule at the site just before the scar began to develop.

Dr Sunita Puri of Decatur, Ala, writes that the clinical diagnosis was keloid. This abnormal reparative reaction to a skin injury is characterized by proliferation of fibroblasts and collagen and extends beyond the site of the original wound; in contrast, hypertrophic scars remain within the wound margins. Keloids are most often associated with body piercing, burns, insect bites, acne lesions, and lacerations. Often linear and hyperpigmented, these scars are more common in black persons and most often occur between puberty and the third decade of life.

During their active growth, keloids are tender and pruritic. As years pass, these lesions continue to expand and may develop clawlike projections. Keloid has a genetic predisposition. Common areas of keloid formation are the upper trunk, deltoid area, and ear lobes; keloids rarely affect the mid face.

Intralesional corticosteroid injection may reduce the size of the keloid; however, improvement is slow and incomplete. These injections can be used in conjunction with cryosurgery with liquid nitrogen. Topical retinoid cream has been partially effective. Surgical excision of a keloid is often followed by the growth of a larger lesion; use of corticosteroids, Silastic gel sheets, and pressure bandaging may retard new scarring. Newly developed keloids may regress with the application of topical corticosteroids covered by occlusive foil.

This patient is undergoing intralesional corticosteroid therapy. If treatment is unsuccessful, she will be referred to a plastic surgeon.

REFERENCE:1. Freedberg IM, Eisen AZ, Wolff K, et al, eds. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York: McGraw-Hill; 1999:1164.