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Keloids are smooth overgrowths of fibroblastic tissue that arise in an area of injury (eg, lacerations, surgical scars, truncal acne) or, occasionally, spontaneously.
Keloids are more frequent in blacks. They tend to appear on the upper trunk, especially the upper back and mid chest, and on deltoid areas. Unlike hyperplastic scars, keloidal scar tissue always extends beyond the area of original injury.
Keloids are shiny, firm, smooth, usually ovoid but sometimes contracted or webbed, and slightly pink or hyperpigmented. Diagnosis is clinical.
Treatment
Treatment is often ineffective. Monthly corticosteroid injections (eg, triamcinolone acetonide 5 to 40 mg/mL) into the lesion sometimes flatten the keloid. Surgical or laser excision may debulk lesions, but they usually recur larger than before. Excision is more successful if preceded and followed by a series of intralesional corticosteroid injections. Gel sheeting (applying a soft, semiocclusive dressing made of cross-linked polymethylsiloxane polymer, or silicone) or pressure garments are other adjuncts to prevent recurrence.
Last full review/revision September 2008 by Daniel W. Collison, MD
Content last modified June 2010
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