AN-cicatrices chéloïdes

Keloid scars

Keloid scars are inflammatory scars that appear thick, hardened and puffy. This phenomenon is caused by an overproduction of collagen in the dermis during the repair of the connective tissue, where fibrous scar tissue replaces the normal skin tissue. This overproduction is accompanied by an overgrowth of dermal cells: the fibroblasts. This unsightly growth of the dermis can occur as a result of skin trauma, injury, shingles, burns, folliculitis, certain skin diseases such as acne, scarring after a vaccination, or after an incision or surgery. Keloid scars can be painful and can cause itching and irritation.

A distinction must be made between hypertrophic scars and keloid scars. Hypertrophic scars begin to flatten after several months and fade. This is not the case for keloid scars, which do not improve spontaneously.

Beyond 12 months and below 18 months, we speak of hypertrophic scars. A thickened and swollen scar beyond 18 months is no longer considered hypertrophic but keloid.

People with black skin or Asian people are frequently affected by keloid scars.

White-skinned people can suffer from it, but this is more rare.

These unsightly scars are often found in children or young people and the most common locations are the sternum, shoulders, pubic area and lower face.

Keloid scars never improve or regress spontaneously. These scars can remain stable or even, on the contrary, progressively widen, this phenomenon being caused by the excessive formation of collagen in the dermis (and by the excessive development of the dermis cells, the fibroblasts). It is a bit like an “excess of healing”, a healing that never stops…

How can we prevent an incision, a wound or a burn from generating a keloid scar? There is no miracle solution but it is recommended to avoid a suture that pulls on the skin when possible or to apply a waterproof silicone film very quickly to avoid the evaporation of the water in the skin. For a long time it was thought that a scar should be dried out, but in fact the opposite is true: it should be kept moist to avoid evaporation, which increases collagen secretion.

The other solution to prevent keloid scars is the practice of pressotherapy. This consists of permanent and mechanical compression on the keloid scar in order to flatten and soften it. This method is very effective if the permanent compression is well followed. This compression will reduce the diameter of the fibrocollagen and regulate the size of the blood vessels. It is as if the fibroblasts of the dermis, which are growing too much, were asphyxiated. The duration of a pressotherapy is about 6 months and is carried out thanks to elastic compression garments adapted to the morphology of each patient. When the keloids concern the ears or the face, compression is carried out using silicone dressings (applied 24 hours a day), ear clips, etc.

There is currently no treatment for these scars. When the keloid scar is formed, the choice of treatment depends very much on its intensity. These treatments can be either cortisone injections into the scar to reduce the intensity of the inflammatory phenomenon, or cryotherapy (a treatment based on exposing the scar to intense cold), or radiotherapy.

On the other hand, surgery to treat a keloid scar is not recommended. This would run the risk of returning to a keloid scarring phenomenon.