Keloid is a product of excessive proliferation of fibrous connective tissue and is a type of fibroma, called crab foot swelling or giant scar in Chinese medicine. Keloids develop slowly but continue to increase in size, and some patients occasionally have malignant changes (those with recurrent infections and ulcers). Keloids are found on the chest, shoulders, neck, back and auricles, and can occur in both men and women. Keloid scars are related to the body type. Anyone with keloid scars has a high probability of forming keloid scars if the epidermis is damaged, such as trauma, mosquito bites, vaccination, burns, folliculitis, acne, etc. Local factors include post-traumatic inflammation, foreign body irritation, and excessive tension. What are the causes of keloid scars? 1. Genetic factors Keloid scars are closely related to genetics, and apparent keloid population is sometimes associated with allergies. It is easy to occur in people with pigmented skin. People with acne-prone skin, obscure dry skin, oily skin, and sweaty skin are prone to develop them. It is likely to occur in areas with poor venous lymphatic drainage. Chest keloids are more likely to occur in people with well-developed breasts. 2, keloid The keloid refers to even very minor trauma, such as a mosquito bite, can cause the skin to produce a scar that is larger than the trauma, grows outward, and does not fade in the short term. People with keloid scars are prone to form symptomatic hyperplastic keloid scars or keloids after surgery, burns, or trauma. Currently, medical diagnosis of keloid can only be made based on the individual’s presentation, but there is no real way to test whether a person is a keloid through any one laboratory indicator. In fact, there are very few people who are truly keloid. The diagnosis of keloid is subject to judgment, and the treatment should be very careful, sometimes the benefits outweigh the losses after treatment. 3. The degree of injury Proliferative scarring and the degree of injury are closely related, but also related to factors such as physique, age, and location. Thinness and obesity, especially women in the development period, are more common. This is due to the excessive proliferation of fibroblasts during the healing process of trauma in these people. Secondly, minor trauma, such as mosquito bites, vaccinations, ear piercing, eyebrow tattoos, and needlestick injuries can cause keloid scars to occur. Keloid sites Occurrence sites: upper outer arm (deltoid), anterior chest, and scapula are the most common sites for keloid scars, as well as behind the ear, auricle, neck, occipital area, and upper pubic bone. In contrast, keloid scars are less likely to occur in areas of loss of innervation (mange) and spinal cord paralysis. There is no specific site of predilection for proliferative keloids, including all keloid sites, as well as the medial canthus, jaw, mid-abdomen, lateral chest, buttocks, groin, thighs, hands and feet, and joints of the extremities. The areas that are not prone to hyperplastic scarring and keloids are the scrotum, eyelids, areola, and scalp. It is not uncommon for people with significant keloidism to be prone to keloid scarring in all areas without differences in the preferred site. However, there are many cases of keloid scars forming at the preferred site and hyperplastic scars forming at other sites, e.g., longitudinal surgical incisions for planarian delivery, often with hyperplastic scars at the upper part and keloid scars at the pubic bone. Symptoms and clinical manifestations of keloid scars Keloid scars are a supernormal nodular tissue reaction of the body to a variety of skin injuries. The keloid is a tumor-like growth on the elevated skin surface, with a smooth, red and shiny surface, and often found with dilated capillaries. The skin lesions protrude outward from the edges and are crabfoot shaped. The skin lesions vary in size and shape and are hard and cartilage-like in texture. The condition develops slowly and most of them continue to increase in size. Some of the scar epidermis and surrounding tissues are shiny and slightly white. It rarely retracts on its own and occasionally becomes malignant. Keloid scars can be classified as spontaneous (idiopathic) or secondary: 1. Spontaneous keloid scars: they occur on normal skin without obvious cause or are caused by unnoticed minor abrasions, resulting in hard nodules that grow gradually with irregular edges and expand to the periphery, forming crab feet or centipede, butterfly or round shapes, hard, light or dark red, itchy and sometimes accompanied by paroxysmal sharp pain or tingling. or tingling. 2. Secondary keloid scars: usually occur in skin burns, infections, traumas and wounds. For example, scar hyperplasia caused by freezing, laser, mole removal, eyebrow washing, ear piercing, prophylactic injection, surgical skin implantation, caesarean section, etc. The symptoms are aggravated by the consumption of spicy food, wine and other stimulating foods. Treatment of keloid scars 1. Injection therapy Intra-lesion injection of deferensone-A is currently the most effective therapy and has been widely used in the treatment of keloid scars. 10mg/ml of deferensone-A injected into K can produce therapeutic effects. It works by inhibiting the proliferation of normal and keloid fibroblasts, inhibiting collagen synthesis, increasing collagenase production, decreasing collagenase inhibitor production, causing changes in collagen ultrastructure and ordering the arrangement of collagen fibers, and also degrading the characteristic collagen nodules in K. 2. Compression therapy Compression therapy used after excision of keloids can show its effect of reducing the recurrence rate. The use of compression after excision of K in the earlobe has resulted in up to 80% absence of recurrence, and the mechanism of action may be a change in the tension of the wound. It may also be that pressure causes tissue ischemia, promotes collagen degradation and changes the biological activity of fibroblasts. 3. Laser treatment The efficacy of laser on keloid scars is not obvious. After excision K with CO2 laser alone, there is a 50% recurrence rate. Some studies have shown that keloids are more than 75% effective for 585nm flash-pumped pulsed dye laser treatment. 4. Silicone gel The mechanism of action of silicone gel is to act as an impermeable membrane that keeps the skin in a hydrated state and functions similarly to the normal skin stratum corneum. The use of silicone gel film, local can cause dampness, rash and erythema and other changes, as long as the suspension of use for a few days, can subside, and can again. It can be applied alone or to wounds after excision of K. The use requires continuous patching for more than 12h per day, preferably 24h continuous patching. In addition to the daily cleaning time of the local area, the treatment should last for 4-6 months after surgery. 5.Surgical treatment The recurrence rate of keloid simple excision is as high as 40%~100%. Using subexcision method (within the range of keloid) together with subcutaneous latent separation method reduces the recurrence rate due to the operation of stimulating collagen. k After excision, if subcutaneous suture can be performed to reduce the tension of skin sutures, the recurrence rate can be reduced. single strand silk thread is used, same as reducing the inflammatory reaction, which can reduce the recurrence. The early removal of sutures after surgery can also reduce the recurrence rate. 6.Radiation therapy Radiation therapy as an adjuvant therapy after surgical resection, its efficiency can reach 65% to 99%. Radiation therapy can directly damage fibroblasts and affect the structure of collagen and the arrangement of collagen fibers. In vitro studies have identified that radiotherapy can induce apoptosis of KFB. Early initiation of radiation therapy after surgery does not cause wound dehiscence, although it is not recommended for children and pregnant women, and should be used with caution if there are important internal organs on the deep side of the lesion. Prevention of keloid scars In terms of diet, irritating foods such as wine, chili, lamb, raw garlic, ginger, mustard, and coffee can also promote scar growth. If you take drugs containing lead and tribute, it will promote pigmentation. Secondly, sun protection is also not to be neglected, especially in high summer, when the sun is hot and abundant, and the newborn skin is tender and difficult to resist the ultraviolet radiation in the sunlight, which can easily form pigmentation; cosmetics, soap, etc. should not touch the wound, because various cosmetics inevitably contain heavy metals and photosensitive substances such as lead, tung, and silver, which can stimulate the increase of skin pigmentation.