KELOID (CHELOIDES–LAT GROWTHS RESEMBLING CRAB LEGS)
A TUMOR LIKE CONDITION–GROW BEYOND THE WOUND EDGES TO INSULT PREVIOUSLY NORMAL TISSUE
INCREASED DISORGANIZATION OF TYPE III COLLAGEN BUNDLES
EXCESSIVE MUCIN AND EOSINOPHILIC COLLAGEN
HIGH PROLINE HYDROXYLASE (SYNTHESIS) AND HIGH COLLAGENASE (CATABOLISM)
INCREASED IgG
PROBABLY SUSCEPTIBLE TO MSH (MELANOCYTE STIM HORMONE)–BLACKS 15:1 WHITE
PRIMARY LOCATION IS EAR LOBE
Rx : EXCISION—IS OF THE DERMIS SO A PLANE IS DIFFICULT
DO NOT LEAVE A RIM OF KELOID
LASER IS REALLY NO BETTER THAN THE KNIFE
INTRA – OP STEROID INJECTIONS ARE A GOOD IDEA
CAN USE POST – OP TRANSCUTANEOUS STEROIDS (DERMOJET–TRIAMCINOLONE AND LIDOCAINE)
+/- TOPICAL SILICONE GELS OR SHEETS
POST OP RT—4 Gy/DAY ON POST OP DAY 0, 2, AND 4—ONLY FOR AURICULAR KELOIDS
—PRESSURE DSGS USUALLY NOT WELL TOLERATED?
INJ GAMMA IFN–SHOWING PROMISE
LATHROGENS?—TOXINS FROM LEGUMINOUS PLANTS
HYPERTROPHIC SCAR
REMAIN WITHIN THE ORIGINAL INJURY FIELD