Definition. – A connective tissue new-growth appearing as a tense, smooth, firm, reddish, shining, variously shaped patch or ridge.
Symptoms. – This growth is most often found over the sternum and less often on other parts of the upper trunk, face, ears, neck and extremities. It is often appear after some injury to the skin no matter how slight. Keloid is usually a single growth starting as a pea-sized nodule which in the course of years slowly increases. However, it may be multiple and present much variety in size and shape. It is a benign tumor and never threatens life, though it may be painful and often recurs when excised. When seen by the physician there is usually an elevated patch or ridge of skin from 1/4 to 1/2 inch in height, variously sized, pearly or rosy tinted, tense, smooth and shining. From one or both ends or from the sides of the ridge, fleshy prongs project into and blend gradually with the surrounding skin. The “false keloid” or hypertrophic scar is a mass of fibrous tissue which occurs around a healing or healed wound.
Fig. 119. – Keloid of ten years’ duration on the breasts, abdomen and back of a negress. The X-rays relieved the itching and pain but failed to diminish the size of any of the twenty-one growths.
Etiology and Pathology. – The negro races are more subject to the disease than the white, and although it has been observed at all times of life and in both sexes, it occur usually in middle-aged persons. Its exact cause is not known and the condition simply represents a peculiar tendency to fibrous connective tissue overgrowth frequently following traumatisms, no matter how slight. The papillary layer is usually intact while the overgrowth is found in the middle and lower layers of the corium.
Diagnosis. – The ridge-like shape, smooth surface, pinkish color and claw-like prolongations will nearly always serve to distinguish keloid from all other growths. A hypertrophic scar might approach it in appearance but a history of a wound at the exact site of the lesion, lighter color, less elevation and absence of fleshy prongs will readily differentiate the scar. Fibroma may need to be considered in a diagnosis.
Prognosis and Treatment. – These tumors usually persist through life though they may disappear spontaneously. Fortunately the patient’s general health is not affected. Although there exists a great amount of pessimism about all forms of treatment, I may say that surgical removal, preceded and followed by careful X-raying, has given good results in some of my cases. Excision, cauterization, linear scarification and electrolysis are of little avail because the growths return with renewed force and increased size. A number of methods have been used with partial success, such as local applications of the high-frequency spark, sodium chlorid ionisation, solidified carbon dioxid (one or two minutes’ application for small keloids), hypodermic injection of fibrolysin (thiosinamin), or applications of mercurial and salicylic acid plasters following the use of Bier’s suction cups. Remedies such as Calcarea flour., Fluor. acid, Graphites and Nitric acid have little effect if used alone, although associated symptoms should be carefully prescribe for.