The keloid phenomenon: Progress toward a solution

Abstract

For centuries, keloids have been an enigma and despite considerable research to unravel this phenomenon no universally accepted treatment protocol currently exists. Historically, the etiology of keloids has been hypothesized by multiple different theories; however, a more contemporary view postulates a multifactoral basis for this disorder involving nutritional, biochemical, immunological, and genetic factors that play a role in this abnormal wound healing. Critical to the process of preventing or managing keloids is the need to locally control fibroblasts and their activities at the wound site. In recent years, considerable evidence has accumulated demonstrating the importance of fatty acids and bioactive lipids in health and disease, especially those involving inflammatory disorders or immune dysfunction. If hypertrophic scarring and keloid formation can be argued to have significant inflammatory histories, then it is possible to postulate a role for lipids in their etiology and potentially in their treatment. This report briefly visits past views and theories on keloid formation and treatment, and offers a theoretical rationale for considering adjuvant fatty acid therapy for keloid management. Sufficient scientific evidence in support of fatty acid strategies for the prevention and treatment of keloids currently exists, which offer opportunities to bridge the gap between the laboratory and the clinic. The intent of this paper is to serve as a basic guideline for researchers, nutritionists, and clinicians interested in keloids and to propose new directions for keloid management.

Surgical Excision and Immediate Postoperative Radiotherapy versus Cryotherapy and Intralesional Steroids in the Management of Keloids: A Prospective Clinical Trial

“…They found no statistical difference between the two treatment arms. A recent study suggests [2] that treatment with topical, intralesional and oral fatty acids may have a potential benefit in keloid management. Overall, there is no universally accepted treatment for keloids and its management has to be adapted to the patient's age and keloid distribution, size and thickness, consistency of the lesion and associated inflammation.…”

Unusually Located Keloids - The Role of Cultural Practices in its Etiology

“…There is increased collagen production and collagen breakdown, but the balance is such that excess collagen is produced. Such scars will eventually mature to become pale and flat, and it is this spontaneous resolution which distinguishes hypertrophic scars from keloid scars [12]. Hypertrophic scars typically occur in wounds where healing was delayed, perhaps where complications such as infection or dehiscence occurred.…”

The Role of Eumelanin in Generating Reactive Oxygen and Reactive Nitrogen in Solution: Possible Relevance to Keloid Formation

“…People of color are particularly susceptible to keloids, a recalcitrant consequence of aberrant wound healing, characterized by excessive collagen deposition that extends beyond the original wound [9][10][11]. The etiology of keloids is complex, and both genetic [12] and epigenetic [13] factors are involved.…”