Recurrence of Primary and Secondary Keloids in a Select African American and Afro-Caribbean Population

Abstract

Background Keloid formation occurs with increased incidence in African Americans and Afro-Caribbeans when compared with other ethnic populations. Although surgical management and nonsurgical management of keloids are mainstays of treatment, there are significant variations within studies comparing the efficacy of intraoperative steroid injection, postoperative radiotherapy, or a combination of both modalities. The purpose of our study is to evaluate the efficacy of different treatment modalities used for treatment of keloids and to determine their recurrence in a select Afro-Caribbean population. Methods A retrospective review of the plastic surgery case list from January 2015 to October 2019 was conducted, with identification of 46 Afro-Caribbean and African American patients with 56 keloids. Each patient was contacted to determine whether they had experienced recurrence of their keloid(s). Eighteen patients were lost to follow-up, resulting in 28 patients with 35 keloids included in our study. The treatment protocol involved surgical excision for all keloids, with selective additional triamcinolone 40 mg/mL injection intraoperatively, immediate postoperative radiotherapy, or intraoperative triamcinolone injection with postoperative radiotherapy. Recurrence rates between the different treatment groups were calculated, and statistical analyses were performed using IBM SPSS Statistics, with a value of P < 0.05 deeming statistical significance. Results Our study demonstrates that postoperative recurrence rates of primary and secondary keloids were 43% and 58%, respectively. Results of recurrence rate varied by specific treatment modality; keloid excision yielded a rate of only 54%, keloid excision with postoperative radiation yielded a rate of 83%, keloid excision with intraoperative triamcinolone injection yielded a rate of 33%, and keloid excision with a combination of intraoperative triamcinolone injection and postoperative radiation yielded a rate of 33%. Conclusion Patients of Afro-Caribbean and African American ethnicity are more heavily affected by the formation of keloids compared with other population groups. Results of varying modalities for keloid management demonstrate that patients who received a combination of excision with intraoperative triamcinolone injection, with or without postoperative radiation, had the lowest recurrence rates compared with other treatment protocols including excision alone and excision with postoperative radiation only.

The effects of systemic diseases, genetic disorders and lifestyle on keloids

“…8 African Americans have also been described with higher incidence rates of keloids than Caucasians, and correspondingly, a similar pattern is observed in hypertension morbidity. 9,10 Anti-hypertensive drugs, particularly angiotensinconverting enzyme inhibitor (ACEI) such as Captopril, 11 and calcium-channel blocker such as Verapamil, 12 have been shown to be effective in keloids treatments (Figure 2).…”

“…Conversely, severe hypertensive patients have been reported to have more tendency to develop multiple and/or large keloids 8 . African Americans have also been described with higher incidence rates of keloids than Caucasians, and correspondingly, a similar pattern is observed in hypertension morbidity 9,10 …”

“… 8 African Americans have also been described with higher incidence rates of keloids than Caucasians, and correspondingly, a similar pattern is observed in hypertension morbidity. 9 , 10 …”

Healthcare Disparities in Otolaryngology

“…Other areas with significant attention include cultural and racial/ethnic differences in desired cosmetic surgery outcomes such as facial rejuvenation and appropriate dermatologic care for different skin tones. Keloid formation has been another topic of study with differences based on race/ethnicity [ 128 , 129 ].…”