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What is a Keloid?

(NEW YORK, NY, March 28, 2012) – Dr. Oleh Slupchynskyj, Director of The Aesthetic Institute of New York and New Jersey, has begun a humanitarian effort to help a Kenyan man afflicted with massive, painful facial tumors known as keloid scars. Due to his impoverished situation and the lack of qualified medical care for this condition in Kenya, this patient has been unable to find help. Late last year, he reached out to Dr. Slupchynskyj, a facial plastic surgeon with experience and expertise in keloid scar removal.

53 year old African man with massive keloid scarring of the neck and chest area. Father of five children who has been unable to secure a job and provide for his family due to social stigma from this disfigurement.

Dr. Slupchynskyj has agreed to treat this patient free of charge. However, due to additional expenses associated with his care, including travel, lodging and some hospital facility fees, the Doctor is reaching out to others who can provide financial assistance to help bring this patient here and make his surgery a reality. If you are interested in making a donation to this cause or perhaps assisting this patient in another capacity (like the recommendation or sponsorship of lodging), please contact the Patient Care Coordinator Cara at cara@facechange.org or call the office at the number below to speak with her.

What is a Keloid?

Keloid scars are defined as scars which grow out of the regular confines or boundaries of a skin injury whether it be a surgical scar, ear piercing or inflammatory process such as a pimple, simple scratch and areas of the body that have ingrown hairs such as the scalp and pubic area. Keloid scars affect predominantly the patients of African descent but are also seen in patients of Indian and Asian descents and less commonly Caucasians, though they still occur. In certain ethnicities, scarring the skin of the body is part of a ritual belief. This is a form of "tattooing" that is spiritually protective. Skin scarring has also been used for "body decoration" depicting courage and endurance. In truth, body tattooing and piercing is popular in Western societies too, however, keloid scarring is not a typical consequence.

Keloid scars are firm, rubbery, fibrous lesions that can be flesh colored or red to brownish in color. Grossly, keloids can appear hard and angry, "more aggressive" or, even soft and fleshy. There is some evidence that keloid scars vary in aggressiveness in terms of their growth and their recurrence. These scars can sometimes be confused with hypertrophic scars, which do not grow out of the boundaries of the original wound.

Biologically, keloid scars tend to have deficiencies or an excess of the hormone melanocyte. They also show decreased and poorly developed collagen fibrils, which grow to excess. There is some speculation that keloid scars form as a result of a faulty inflammatory or healing process after skin injury. In early keloid scars, there is an abundance of collagen type III and in late stage or mature keloids, collagen type I is predominant. There is also excessive deposition of fibronectin, elastin, and proteoglycans. Histologically, keloids are acellular with thick collagen bundles deposited within the thick dermal skin layer. There also appears to be a genetic link for patients with keloid scarring. If you have a family member with a keloid scar, you are then more likely to develop a keloid.

Although keloids are not typically malignant, they can grow to be quite large and unsightly. Keloid scars can become chronically infected, cause pain and bleeding. In very rare instances, keloids can degenerate into malignancies. Keloid scars can grow on any part of the body but most typically on the chest, back, shoulder, abdomen and face including the ears, cheek, scalp, and neck area. However, I have never seen keloid scars form in the T-Zone area of the face. Keloid scars can also form in the genital area such as the female vulva and the penile shaft.

As keloid scars grow larger, they are more prone to become infected, cause pain and bleeding. In addition, the appearance can cause significant psychological stress especially if they grow on the face, pubic area and chest area of females.

Treatment for Keloids Scars and Keloid Scar Removal

Treatment for keloid scars have included surgical excision with or without radiation therapy, Cryotherapy (freezing), steroid injections with Triamcinalone, 5-FU injections, interferon as well as various silicone patches, creams and pressure bandages. In my practice, some of the obvious causes of keloid recurrence include, incomplete excision of keloid scars or in adequate treatment of the keloid such as low dose steroid therapy or low dose radiation therapy. Radiation therapy is critical as it interferes with fibroblast and collagen production in the first phases of healing therefore eliminating the initial onset of keloid scar formation. However, not all patients are willing to undergo radiation therapy and some patients are not candidates for radiation therapy. I have successfully treated hundreds of patients every year with unsightly keloid scars, which were inadequately treated previously by other doctors.

Currently, my protocol for keloid scar treatment includes complete excision of the keloid followed by an adequate dose of Radiation Therapy (12Gy). The radiation for keloid scars must be performed within 24 hours of excision and treatment is divided over three consecutive days. Some patients will require steroid injection and silicone sheeting post-operatively as well. Even with the best treatments, Keloid Scar recurrence can be from 25% to 40%. In my own series of keloid scar patients, I have noticed that recurrence after surgery and radiation is lowest in the cheek and scalp area. I believe this is because there is less tension on the wound in these parts of the body.

Keloid scars have been somewhat neglected in the medical community because they are typically not malignant nor life threatening; however, patients with keloid scars are sometimes undertreated by physicians for years. Some examples include inadequate low dose steroid therapy, inadequate surgical removal techniques in including incomplete removal, laser therapy and scraping of keloid scars. Unfortunately, these treatments just make matters worse.

Keloid scars also affects a minority patient population and are therefore not considered "sexy" in plastic surgery, as are newest facelifting techniques, for instance. In the US and around the globe, many patients with keloid scars are left frustrated with inadequate treatments, persistent growth and recurrence. I have seen many patients who have been turned away by other surgeons because of the sheer size and complexity of the keloid scarring. As one can imagine, there is probably a bigger problem with keloid scars in certain parts of Africa where poverty and non-existent medical facilities are commonplace.

Below is a patient that suffers from facial keloid scarring. Again, although keloid scars are usually not life threatening, they can debilitate a person socially and mentally making it impossible to live a normal life, secure employment due to their disfigurement and thus provide for their families.

 
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