Keloid

The keloid is an emerging through excessive growth of fibroblasts, the skin level superior benign tumor that after injury ( Keloids ), surgery, or may occur as Spontankeloid and is to be regarded as a disturbed healing process. People with dark skin are more frequently affected than light skinned.

Is distinguished from keloid hypertrophic scar.

Pathogenesis

The cause of keloid formation is not yet fully understood, but a genetic predisposition is safe. The activity of fibroblasts is influenced among other things by growth factors from inflammatory cells and of epidermal keratinocytes. Through an unhappy combination of these factors appears to be the balance between synthesis and degradation of the dermal collagen is moved.

In contrast to the hypertrophic scar is the keloid on the original injury can also extend to undamaged skin.

Symptoms

The keloid presents as a bulge on the skin level raised tissue proliferation. The color can vary from pale pink to deep red, consistency is hard - elastic to hard. Preferred sites are the chest, back and shoulders. Usually there are up to the aesthetic impairment no complaints, sometimes itching, tenderness and dysesthesia may occur.

Therapy

The treatment of keloids is difficult to be so often " tried " several therapeutic approaches in order to achieve a satisfactory result. Are widely hedged clinical results for only a few procedures. The psychological pressure and thus the therapy the patient's willingness depends on the degree of aesthetic impairment.

Surgical treatment

The sole of a keloid excision with primary wound closure is outdated method because it comes to re keloid in the scar area. The OP is therefore (eg, injection of corticosteroids or interferon ) combined with a treatment that is intended to prevent recurrence. Other methods provide tissue transplantation of keratinocytes or the use of split-thickness skin dar.

General drug therapy

A general medical treatment has not yet been known. But Japanese researchers reported that in patients with an antifungal agent ( itraconazole) were used to treat fungal infections, by the way a dramatic improvement in the keloid was observed.

Local drug therapy

The local, intralesional injection of corticosteroids (eg triamcinolone ) is the most widely used method for the treatment of keloids. The effect is due to a reduction in the production of collagen in fibroblasts. A questionable alternative is the external treatment with corticosteroid creams, ointments or patches, because the timely drug absorption must be questioned in sufficient strength.

In addition to corticosteroids isolated cell growth inhibitory cytostatic agents such as 5 -fluorouracil or bleomycin are used.

Occlusion therapy

Another method is the covering of the scar tissue with silicone foils, or silicone gel. As mechanisms of this occlusion and hydration effects are assumed.

Cryotherapy

The local application of cold is a complex and lengthy procedure, the effect of which is based on the change in the micro- circulation in the keloid. In several meetings, the lesion is frozen by means of the contact or spray method, thereby reducing gradually. A disadvantage is the long healing time after the application of cold and unwanted skin depigmentation dar.

Compression treatment

Locally acting pressure in the keloid leads to a longer duration of treatment is also a flattening of the scar. The pressure treatment is performed usually with compression bandages, occasionally supplemented by plastic masks or snaps at special points. Particularly suitable are also silicone products, which are applied with pressure. The treatment effect is a rather slow, the duration of treatment can be more than two years. The method is - also used for the prevention of keloids after surgery - with the appropriate disposition. The compression treatment is already being used against hypertrophic scars after burns longer successful. It must be noted that the quantitatively excessive, so-called hypertrophic scars pathogenesis is not like the keloid.

Ionizing radiation

A proven therapeutic approach is the use of ionizing radiation. If a disturbing keloid is surgically removed, the recurrence rate without subsequent treatment is very high. The application of the radiation (for example, 5 x 3 Gy) is very likely to prevent this recurrence. Radiation therapy should necessarily begin within the first few hours after surgical excision of the Keloides ( urgently requires prior coordination of the surgeon and radiation oncologist ) R40 s.Leitlinie the DEGRO.