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During my busy outpatient Clinic on Wednesday, a young man came in. He kept nervously pulling at his collar to hide a hard, raised lump on his chest. He told me it started as a small pimple a year ago, but after he scratched it, the scar started growing out of control, always itching and hurting.
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In our communities, people see these fast-growing, raised marks and think they are from traditional poisoning, bad luck, or some strange skin sickness.
But when we look at this with our medical eyes at the clinic, we know it is a very common, and personal skin problem: called a KELOID.
The reason a keloid forms is a classic case of the body’s healing system working too hard and not knowing when to stop. In a normal skin injury, the body follows a careful step by.step plan: platelets close the cut, swelling clears out dirt and germs, and cells called fibroblasts rush in to build a temporary net of collagen to close the wound. Once the skin is fixed, the body usually sends a chemical message to stop making more tissue, break down the extra, and let the scar heal properly.
But in people who are born with a risk for keloids, that STOP message never comes. The fibroblasts go into overdrive, always making huge, messy piles of Type I and Type III collagen. This fast overgrowth acts like a harmless tumour of the skin, spreading into the healthy skin around it and growing far past the edges of the first injury.
This fast spreading is exactly what makes a keloid different from a normal thick scar. A thick scar may get raised and red, but it stays only inside the edges of the first wound and often gets smaller with time. A keloid has no limits.
If you look at the Collage image attached for medical illustration purposes, you can see the typical examples we see every day in the hospital. One of them is at the bottom right, which shows a butterfly shaped keloid on the breastbone, which is the most common place seen in men, because the skin on the chest is pulled tight. It also shows other common spots with tight skin: the upper arm near the shoulder, a small lump on the earlobe usually caused by a simple ear piercing, and a large, raised growth that follows an old surgery scar from a parotid gland operation. Any small injury, a surgery cut, a piercing needle, a BCG shot, or even bad acne, can start this collagen explosion.
Treating keloids at the hospital needs a lot of care, because the old habit of just cutting them out with a knife is a sure way to make things worse. If we cut out a keloid without any other treatment after, you are just making a new, bigger injury. The overactive fibroblasts will then build a keloid that is twice as big as the first one.
Instead, our medical plan uses many methods together depending on the size of the Keloid. The main treatment is giving regular shots of a strong steroid, commonly used in our setting is Triamcinolone Acetonide, right into the keloid once in 7 to 10 days of 6 to 8 injections. Putting the steroid straight into the thick tissue lowers the swelling, turns off the overactive fibroblasts, and makes the scar get softer and flatter over time. For hard cases, we combine surgery with fast, strong extra treatments, like putting steroids right into the edges of the cut during the operation, using silicone gel sheets, or using tight pressure bandages to cut off oxygen to the tissue and stop it from growing back.
