Keloids

Abstract

Keloids are common in black Africans but rare in causasians OJorman, 1969). They have a familial tendency and may follow any type of trauma physical, chemical, thermal etc., however trivial it may be. Some people have a greater tendency to progressive keloids formation all over the body and recurrence after surgical excision than others (Norman 1969). The condition is not fatal but can create serious psycho-social problems to the patient. In many patients it causes physical discomfort such as itching, pain, ulceration, sinus formation and infection. In some patients keloids especially in neck and flexural aspects of the limbs cause severe disability and functional loss. At present there are no facilities for radiation therapy in Zambia. Many patients go elsewhere for treatment incurring heavy expense and most of them develop recurrence sooner or later. It was therefore decided to undertake a clinical study of keloids with special reference to intra- marginal excision with or without local corticoids. This paper is based on the initial analysis of 57 keloids of various sites from an on-going prospective study. Of the total 57 cases of keloids, 8 cases of massive keloids were treated by diathermy excision and immediate skin grafting; 35 keloids of ear lobule by intra-marginal excision and post-operative local hydrocostisone;7 presternal keloids by local corticoids alone and a miscellaneous group of 7 cases of keloids were treated by combination therapy. It is concluded that massive keloids with or without sinuses and keloidal contractures require surgery to improve appearance and function respectively. Ear lobule keloids are best treated by intramarginal excision and post-operative local hydrocortisone. Presternal keloids and small keloids elsewhere should be treated by intralesional injection of corticoids alone. Initial results of intra-marginal excision with or without local corticoids were satisfactory. However it is too early to claim best result with this regimen, in the absence of long term follow up.