KELOID DISEASE (Case Presentation)

PRESENTED BY

Antony Mamati.

We see what we want?

Common things are usually very rare to spot.

History

A 23 year old female was referred by plastic surgeons for radiotherapy to the posterior ear lobe, following the development of a Keloid Scar, three years after an ear piercing

No family history of keloids

Pathology

Keloid is a unique human dermal fibroproliferative disorder that occurs after injury, inflammation, surgery,and burn.

Commonly causes of keloids include acne, folliculitis, chicken pox, vaccinations and trauma (such as, earlobe piercing, lacerations, or surgical wounds).

It is a benign growth, well-demarcated area of fibrous tissue overgrowth that extends beyond the original defect

Baron Jean-Louis Alibert (1768-1837)

Described appearance “Chele” (crab-claw) (also means: to grab as in “chelation”)

Crab-claw-like Cheloid Keloid

Effects of keloids

Compromise aesthetic Impairment of function

Itchy Pain Prurutic

How best can they be treated?

Treatment Options

Surgery

Intralesional Steroids

Radiation

Laser

Cryotherapy

Pressure

Multimodality Therapy

Still Trying

Surgery Drawbacks

Painful

Difficult reconstruction with large keloids

Utilizes normal surrounding tissue – limiting later reconstructive options

Low long term success as monotherapy

Steroids

Triamcinolone

Hydrocortisone

Dexamethasone

Methylprednisone

Laser 1980s in vogue

Proposed Mechanism

No knife Less tissue trauma

Cryotherapy- cold treatment

Diminishes size and induration (HTS >Keloid) when used as monotherapy

<10% Recurrence when combined with surgery

Photos Courtesy of Dr. Redett

Pressure Therapy

Radiation

Multimodullar

In this case… Plastic surgery was carried out to remove the Keloid

Scar. The patient attended the following day for a single dose of radiotherapy to the scar, plus a small margin of 5mm. The pinna was taped forward to expose the effected posterior section of the lobe.

Radiotherapy prescription

12Gy in single fraction.

HVL 0.2mm Cu

Energy used was:- 100kv.

Actual Field size:- 3.5 x 1.5 cm –margins of

2mm

Cone size used:- 4 X 6cm

Shielding :-A lead cut out was used to define the field size and protect the surrounding

tissue.

Conclusion

A case to think

A 32 year old female

Para 1+0

No family history of keloid

Developed keloid after c-section

Had steroidal injection 4 courses.

Thank You