A 14-year-old adolescent of Hispanic descent is referred for evaluations of skin lesions. The growths were first noted approximately 8 months ago and have rapidly increased in number. All sites are asymptomatic and palpation does not elicit tenderness. No other family members are similarly affected and there is no family history of genodermatoses. Examination reveals a multitude of firm, flesh-colored to slightly erythematous papules and nodules affecting his upper arms, shoulders, and upper trunk.
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Keloids are the result of a hyperproliferative response that is usually induced by trauma. Stimulation of transforming growth factors and cytokines results in accumulation of extracellular matrix components such as collagen, elastin, hyaluronic acids, and proteoglycans.1,2
Linked to keloid formation are platelet-derived growth factor, vascular endothelial growth factor, and insulin-like growth factor. Keloids most commonly occur from adolescence to the third decade; Black individuals are disproportionately affected.3 Lesions can be painful and can significantly impact quality of life.
Spontaneous keloids are an uncommon variant that arise without antecedent trauma or surgery. They are postulated to form secondary to microtrauma or subclinical localized inflammation.4
Treatment of keloids is challenging because surgical removal is often marred by recurrence. Intralesional steroid injections can result in diminished elevation of the keloid but not elimination. Radiation therapy following excision of keloids has also proven beneficial and a recent study demonstrated limitation of recurrence following a single course of superficial radiation administered shortly after keloid excision.5
Brittany Spinosa-Weber, PA-C, is a physician assistant at the DermDox Center for Dermatology in Leola, Pennsylvania. Stephen Schleicher, MD, is director of the DermDox Center for Dermatology in Pennsylvania, associate professor of medicine at Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
1. Andrews JP, Marttala J, Macarak E, Rosenbloom J, Uitto J. Keloids: the paradigm of skin fibrosis — pathomechanisms and treatment. Matrix Biol. 2016;51:37-46. doi:10.1016/j.matbio.2016.01.013
2. Lee HJ, Jang YJ. Recent understandings of biology, prophylaxis and treatment strategies for hypertrophic scars and keloids. Int J Mol Sci. 2018;19(3):711. doi:10.3390/ijms19030711
3. Chike-Obi CJ, Cole PD, Brissett AE. Keloids: pathogenesis, clinical features, and management. Semin Plast Surg. 2009;23(3):178-184. doi:10.1055/s-0029-1224797
4. Jfri A, Alajmi A. Spontaneous keloids: a literature review. Dermatology. 2018;234(3-4):127-130. doi:10.1159/000491924
5. Son Y, Phillips EON, Price KM, et al. Treatment of keloids with a single dose of low-energy superficial X-ray radiation to prevent recurrence after surgical excision: an in vitro and in vivo study. J Am Acad Dermatol. 2020;83(5):1304-1314. doi:10.1016/j.jaad.2020.06.023