Keloid scars or keloid tumors are benign soft tissue tumors formed by the proliferation of connective tissues after skin injury. In the normal healing process of trauma, collagen synthesis and degradation are eventually in balance, but when this balance is disturbed or disrupted, it causes excessive collagen synthesis and deposition, resulting in collagen masses and keloid scars. Currently, keloid scars are diagnosed as keloid scars if they have the following characteristics: (1) lesions that exceed the original skin damage; (2) persistent growth; and (3) nodular, striated, or lamellar masses that are hard and red in color and rise above the skin surface.
I. Etiology
Many patients have scarring constitution, and many of them have scarring without obvious external stimulation, or secondary to trauma, burns, scalds, infection, earring stimulation, injection and surgery.
Prevalent site and age
It occurs mostly in adolescence, and is more common in females, with a female:male ratio of about 1.3:1.
It starts as a light red scar, gradually rises above the skin and expands beyond the original damage, forming a hard and elastic plaque or nodule with a smooth or uneven surface. It can develop on all parts of the body, and is most likely to occur on areas with high skin tension, such as the chest, shoulders, earlobes and vulnerable areas. The upper neck, earlobes, shoulders, chest, and upper arms are known as keloid prone areas. In order of occurrence, the forehead, chest, shoulders, earlobes, upper arms and chin, front of the sternum, back, and collar are the most susceptible areas, which can form severe keloid; the ears, deltoid area, anterior chest wall, facial beard area, and neck are moderately susceptible areas; the abdomen, forearms, and other parts of the face are mildly The abdomen, forearm, and other parts of the face are mildly susceptible areas.
Symptoms
Itchy or painful burning sensation, pain sensitivity; keloid lumps are single or multiple, either in one area or in many places throughout the body, red, hard, poorly elastic, protruding from the surface of the skin, exceeding the original scope of the injured lesion, partly expanding to the surrounding normal skin, also known as “crab foot swelling” or “keloid”. It is also called “keloid tumor” or “scar tumor”; it has a long course, grows gradually, and cannot completely subside by itself for many years; it is very easy to recur after simple excision, and has stronger proliferation ability, faster and larger scope, which is similar to stabbing a hornet’s nest.
Third, the harm of the disease
It affects the beauty, discomfort, normal work and rest, rupture and cancer, psychological burden and physical and mental health.
Treatment methods
There are many treatment methods for keloid scars, and the principles of treatment are: restoring function, improving appearance, orthopedic beauty, relieving itching and pain, controlling growth, and preventing recurrence. Currently, the most appropriate treatment methods are combined surgical and non-surgical, mainly the following: ① surgical excision combined with high-dose rate brachytherapy at the incision; ② surgical excision combined with intra-scar glucocorticoid injection; ③ laser or frozen scar removal combined with high-dose rate brachytherapy or intra-dermal glucocorticoid injection.
1.Surgical treatment
When the duration of keloid scar is more than 3 years, it is not healed for a long time, and the volume is larger than 1.5cm above the surrounding normal skin, and it seriously affects the function, surgical excision and sexual dressing treatment after the incision is healed have good efficacy and are not easy to recur.
2.Drug treatment
Corticosteroid drugs can inhibit fibroblast proliferation and promote collagen degradation. Intra-lesion injection of corticosteroid drugs is effective in 20% of cases, but it is not complete and has a high recurrence rate.
3.Radiotherapy
(1) X-ray treatment: effective, but because x-ray is easy to injure deep and surrounding normal tissues, it is mostly not used clinically.
(2) Radionuclide patching therapy
Therapeutic mechanism: The radionuclide on the applicator releases β-rays during the decay process, which acts on the collagen-producing fibroblasts in the scar tissue. After the fibroblasts are exposed to ionizing radiation, the fibroblasts become degenerated, the nucleus is fixed and the cell membrane disappears to become syncytized cells, thus inhibiting the synthesis and deposition of collagen.
Indications: (1) within 3 years of onset, with an area of 200 cm2 or less, with scar tissue no higher than 1.5 cm compared to the surrounding normal skin or after wound healing after keloid excision; (2) keloid, treated surgically for other diseases, can be treated after removal of stitches, and the earlier the effect, the better.