- What is the diagnosis?
This is a keloid. There is an over-exuberant healing and repair reaction with production of abundant collagenous tissue forming the tumor-like mass. A keloid is an overgrowth of dermal scar tissue that forms over months following the injury. There is disfigurement, but pain and pruritis can also complicate these lesions.
- Why does this happen?
Persons with more darkly pigmented skin are more prone to keloid formation, but it can occur in all races, and there is a genetic predisposition. Skin injuries, such as lacerations, can incite their appearance. Even minor insults to the skin, such as ear piercing in women or acne, may promote keloid formation. Growth factors in the wound induce an overabundant collagenous response.
- What treatment modalities are available?
Although small keloids may respond to intralesional corticosteroid injection, larger keloids must be removed and the resulting wound must be treated to minimize the risk of recurrence. Plastic surgery procedures and corticosteroids can help, but keloids typically recur. Other methods for treatment include radiation, laser or pressure therapy, or silastic gel sheeting. Patients are encouraged to try and prevent them by avoiding injurious situations.
- Name some related lesions involving fibroblastic proliferation.
Hypertrophic scar: similar to a keloid, though it is typically cellular throughout and remains confined to the area of the original scar.
Fibromatosis: an abnormal proliferation of myofibroblasts in a localized area. One form is palmar fibromatosis, or Duyputren's disease, involving the palm of the hand, interfering with finger movement. Plantar and penile fibromatoses also occur (the latter known as Peyronie disease).
Desmoid tumor: a larger abnormal fibroblastic proliferation, typically in soft tissue, such as the abdominal wall (abdominal desmoid) producing a tumor-like effect and pain. Extra-abdominal locations include the thigh and chest wall. Though benign, they have infiltrative borders and tend to recur.
Granulation tissue: this is the normal response to injury, and the process resolves to a small scar.
