Keloid scar

Specialty: Skin.

• keloid
• exophytic hypertrophic scarring
• scarring skin fibrosis

Why it occurs

• Individual genetic predisposition with altered regulation of fibroblasts in the event of any skin injury (common in people of African or Asian descent)
• Previous accidental dermal trauma (lacerations, burns, earring piercings)
• Previous surgical procedures under excessive skin tension
• Severe localized skin inflammation due to nodulocystic acne, chickenpox, or vaccination (typically BCG vaccine)
• Mechanical factors of persistent traction in the healing area.

Initial workup

Morphological evaluation and clinical inspection that determines the difference with hypertrophic scars (which do not exceed the limits of the original wound and tend to spontaneously regress). Skin biopsy is systematically discouraged due to the high risk of inducing new keloid growth, reserved only if there is doubt about the diagnosis of dermatofibrosarcoma protuberans.

Standard management

• Triamcinolone acetonide injectable suspension — first choice intralesional corticosteroid, 10 to 40 mg/mL injected directly into the body of the keloid every 4-6 weeks to reduce collagen synthesis
• Self-adhesive silicone gel patches — continuous daily occlusive application for at least 12 hours a day for 3 to 6 months to promote local hydration and reduce tension
• Imiquimod 5% cream — applied after surgical excision of the keloid to modulate healing and reduce the recurrence rate
• Intralesional fluorouracil (adjuvant or alternative in combination with triamcinolone in resistant keloids).