Keloid management Flashcards
Keloids are a hyperproliferative response to trauma.
T
Keloids appear most commonly in areas of high skin tension.
T Jawline, ant chest, upper back, deltoid
Genetic predisposition does not play a role in the development of keloids.
F
Darkly pigmented individuals form keloids 2-19 times more frequently than Caucasians.
T
New keloid formation is relatively less common in the very young and the elderly.
T
Keloids may regress after the menopause.
T
Significant keloids can occur after minor trauma.
T
Deeper and significant surgical wounds are often more likely to keloid than minor abrasions, burns, insect bites, varicella and zoster, vaccinations and tattoos.
F
Chronic oedema in response to the trauma of ear piercing (and subsequent reaction to the presence of a metal foreign body) could result in increased incidence of keloid formation
T
Infectious agents themselves are likely to cause keloids, accounting for their development following varicella for example.
F Most likely to trauma, oedema, incr wound tension that occurs from infection.
Keloids may grow more readily or appear de novo during pregnancy.
T
Keloids are more common before puberty.
F
Melanocyte-stimulating hormone does not play a role in keloid formation.
F
Collagen synthesis is 20 times greater in keloids than in normal skin.
T
The absolute number of fibroblasts within keloids is increased.
F
Keloids develop rapidly after surgery, whereas hypertrophic scars may occur months after the inciting trauma.
F Hypertrophic scars develop rapidly, keloids develop slowly over months.
Hypertrophic scars may subside with time, whereas keloids generally progress until such time as they become stable.
T
Hypertrophic scars stay within the initial wound footprint, whereas keloid exceed the size of the initial trauma
T
Keloids are more likely to occur in areas prone to excessive motion, whereas hypertrophic scars are most often found in areas with limited or no motion.
F Hypertrophic in areas of motion (eg joints), keloid in areas with less motion (eg chest and back)
Postoperative keloid recurrence is frequently better than the initial lesion.
F Frequently worse.
Stable mature keloids tend to be symptomatic with itching, burning and pain.
F This occurs in progressing lesions.
Keloids of the jaw, neck and anterior chest can cause dysfunction.
T
There are 5 types of earlobe keloids – anterior button, posterior button, dumbbell, wraparound and lobular.
T
Button earlobe keloids have a core component within the lobe.
F This is true for dumbbell keloids.
Wraparound keloids form a cuff around the lobe from one side to the other.
T
Lobular earlobe keloids can be shaved off in their entirety.
F This is true for button keloids.
Pedunculated keloids, particularly when they occur on soft, mobile skin, are amenable to simple excisional surgery.
T
Intralesional corticosteroids are generally the first line treatment for keloids.
T
When used as solo therapy, corticosteroids are most useful in peunculated or raised lesions.
F Most useful in sessile, flat and broad keloids.
The most common cause of intralesional steroid injection failure is the use of overly dilute concentrations.
T Most require 40mg/mL.
The current standard of care with intralesional TCA injection is not to inject more than 80mg per session.
F 40mg per session, so as not to suppress HPA axis.
40mg of triamcinolone is the equivalent of 50mg prednisone
T
Intralesional TCA should not be performed more frequently than every 4-6 weeks.
F Every 2-4 weeks (depending on total dose of steroid used and size of keloid).
Mixing lignocaine with triamcinolone makes the injections less painful.
F Pain of injection is over before lignocaine takes effect. But good for post-injection pain.
Intralesional triamcinolone can be used for prevention of keloids, with injection occurring on the day of surgery.
T One regimen = day of surgery, then at 2, 4 and 6 weeks.
Intralesional corticosteroids can be combined with any other treatment modality to improve keloid treatment outcome
T
Hypopigmentation is an uncommon side effect of intralesional corticosteroid injection.
F Common.
After treatment, the atrophic footprint of the keloid may appear wrinkled or shiny and have telangiectasias. This is unlikely to improve with time.
F Often improves with time.
