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Treating the Elusive Keloid
Arch Otolaryngol Head Neck Surg. 2001;127:1140-1143.
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Hypothesis: Surgical excision with a scalpel, primary closure, followed by local steroid injection is the best treatment for a keloid.
BACKGROUND
The optimal management of keloids continues to be an enigma for surgeons.
The best modality of treatment has been debated for many years. Keloids occur
after dermal trauma, surgery, insect bites, or acne, resulting in excessive
connective tissue formation. Keloids are different from hypertrophic scars
in that keloids grow beyond the boundaries of the original wound area. During
the healing process, it is clinically difficult to determine if a scar will
develop into a keloid or hypertrophic scar. Keloids gradually grow into large,
raised amorphous masses that can cause pruritus, pain, and disfigurement.
Histologically, keloids consist of dense dermal connective tissue with randomly
oriented collagen fibers. The etiological factors that determine how a scar
becomes a keloid remain unknown. Familial predisposition and immunological
causes have been implicated.
Figure appears in full text version.
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