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  • J Cardiothorac Surg
  • v.6; 2011
  • PMC3094374
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J Cardiothorac Surg. 2011; 6: 49.
Published online 2011 Apr 13. doi:  [ 10.1186/1749-8090-6-49 ]
PMCID: PMC3094374
PMID: 21489249

Management of chest keloids

Tae Hwan Park ,1 Sang Won Seo ,1 June Kyu Kim ,1 and Choong Hyun Chang corresponding author1

Tae Hwan Park

1Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Find articles by Tae Hwan Park

Sang Won Seo

1Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Find articles by Sang Won Seo

June Kyu Kim

1Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Find articles by June Kyu Kim

Choong Hyun Chang

1Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Find articles by Choong Hyun Chang
Author information Article notes Copyright and License information Disclaimer
1Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
corresponding authorCorresponding author.
Tae Hwan Park: [email protected] ; Sang Won Seo: [email protected] ; June Kyu Kim: [email protected] ; Choong Hyun Chang: [email protected]
Received 2010 Dec 5; Accepted 2011 Apr 13.
Copyright ©2011 Park et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC.

Abstract

Keloid formation is one of the most challenging clinical problems in wound healing. With increasing frequency of open heart surgery, chest keloid formations are not infrequent in the clinical practice. The numerous treatment methods including surgical excision, intralesional steroid injection, radiation therapy, laser therapy, silicone gel sheeting, and pressure therapy underscore how little is understood about keloids. Keloids have a tendency to recur after surgical excision as a single treatment. Stretching tension is clearly associated with keloid generation, as keloids tend to occur on high tension sites such as chest region. The authors treated 58 chest keloid patients with surgical excision followed by intraoperative and postoperative intralesional steroid injection. Even with minor complications and recurrences, our protocol results in excellent outcomes in cases of chest keloids.

Background

Keloids are relatively resistant to treatment, with high recurrence rates using a single treatment modality. Keloids have a tendency to recur after surgical excision as a single treatment, with rates approximately up to 80-100%. Keloids can arise from skin trauma and must be removed through skin truma. Therein lies the challenge of treatment, where recurrence would seem inevitable. Surgical excision is considered as a kind of skin trauma and it promotes additional collagen synthesis, resulting in regrowth and even larger keloids[ 1 ]. This is why we were focused on the article recently published in your esteemed journal by Patel et al.[ 2 ] that dealt with the challenging topic of chest keloids.

Patients and Methods

58 patients were treated with surgical excision combined with intraoperative/postoperative intralesional steroid injection therapy over a period of six years from July 2003 to June 2009 at our hospital. In all patients, a follow-up period of 18 months was required. Treatment outcome was assessed with global aesthetic improvement score (GAIS). All statistical analyses were conducted using SPSS version 17.0 (SPSS, Inc., Chicago, IL, USA). Our data were not normally distributed; consequently non-parametric tests were used. Descriptive statistics are presented as medians with interquartile ranges or as numbers and percentages.

Results

41 (70.7%) were women and 17 (29.3%) were men. The average age was 32 (range 29-35). The average time interval between keloid formation (or prior complete treatment) and time of treatment was 6 (range 5-7) years. The average pretreatment total size of lesions was 3.5 (range 2.0-5.0). 45 patients (29.3%) were treated for a treatment-resistant keloid that failed to respond to previous interventions. These included surgical excision (2 patients, 3.4%), intralesional steroid injection (33 patients, 56.9%), laser therapy (5 patients, 8.6%), acupuncture (3 patients, 5.3%), and cryotherapy (2 patients, 3.4%). The etiologies of chest keloid, in order of decreasing frequency, were the acne scar (20 patients, 34.5%, Figure Figure1),1 ), cardiothoracic surgery (12 patients, 20.7%; Figure Figure2),2 ), burn scar (10 patients, 17.2%; Figure Figure3),3 ), infection (10 patients, 17.2%) and trauma (6 patients, 10.4%; Figure Figure4).4 ). (Table (Table11 )

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Figure 1

Chest keloid after acne scar.

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Figure 2

Chest keloid after open heart surgery.

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Figure 3

Chest keloid after severe burn injury.

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Figure 4

Chest keloid after shell splinters injury.

Table 1

Baseline Patient Characteristics

Total Patients (n = 58)
Age, years32.00 (29.00-35.00)
Total size, cm3.50 (2.00-5.00)
Age of keloids, years6.00 (5.00-7.00)
BMI, kg/m223.00 (21.00-25.00)
Gender:
Female, n (%)41 (70.7%)
Male, n (%)17 (29.3%)
Previous treatment history:
No, n (%)13 (22.4%)
Yes, n (%)45 (77.6%)
Surgical excision, n (%)2 (3.4%)
Steroid injection, n (%)33 (56.9%)
Laser therapy, n (%)5 (8.6%)
Acupuncture, n (%)3 (5.3%)
cryotherapy, n (%)2 (3.4%)
Etiology:
Acne scar, n (%)20 (34.5%)
Cardiothoracic surgery, n (%)12 (20.7%)
Burn scar, n (%)10 (17.2%)
Infection, n (%)10 (17.2%)
Idiopathic, n (%)6 (10.4%)
Open in a separate window

Values are median(IQR) for continuous variables and number (percentages) for categorical variables.

Discussion

Although various surgical techniques are introduced in the medical literature, surgical excision alone is inadequate considering high recurrence rate of keloids[ 3 ]. In the cases of chest keloids, our treatment protocol was surgical excision with intraoperative and postoperative intralesional steroid injections. Patients were informed of the possible keloid recurrence and were told to return if a scar was reelevated or extended beyond the demensions of the initial lesion. Even with minor complaints, such as pruritus, pain, tenderness, and secondary infection, most patients were satisfied with the outcomes. Diverse adjuvant methods after surgical excision including intralesional corticosteroids injection, pressure therapy, radiation therapy, topical silicone-gel sheeting, cryotherapy, and laser treatment have been proposed for keloids. In the chest keloids, radiation therapy cannot be the primary adjuvant therapy because of its possible risk of radiation-induced malignancy. Thyroid and breast carcinoma after radiation therapy for keloids have been reported in the medical literatures[ 4 ]. In addition, various pressure devices cannot be properly applied on the chest region[ 5 , 6 ]. Even though silicone gel is comfortable and sometimes useful, it requires active patient compliance and long-term application can be challenging[ 7 ].

We also stress adequate follow-up periods are mandatory to properly assess the outcome of treatment protocol. According to available literatures, at least 12 months follow period is recommended.

Conclusions

Although the exact pathogenesis of keloid remains unclear, stretching tension is clearly associated with keloid generation, as keloids tend to occur on high tension sites such as chest region. Therefore, it is difficult to completely eradicate keloids from this region. Even with minor complications and recurrences, we think surgical excision with intraoperative and postoperative intralesional steroid injection remains the treatment of choice in the chest keloids.

Informed consent

Written informed consent was obtained from the patient for publication of this article and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

TH was responsible for the conception and design for the manuscript, the clinical work, the search for the literature, and the editing work. JK helped in the clinical work as well as the design for the manuscript. SW edited the manuscript and helped on the clinical work. CH provided overall supervision and contributed to concept. All authors read and approved the final manuscript.

Acknowledgements

We would like to acknowledge Yun Joo Park M.D. and Ji Hae Park M.D. for helpful assistance in editing the manuscript.

References

  • Niessen FB, Spauwen PH, Schalkwijk J, Kon M. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg. 1999;104:1435–1458. doi: 10.1097/00006534-199910000-00031. [ PubMed ] [ CrossRef ]
  • Patel R, Papaspyros SC, Javangula KC, Nair U. Presentation and management of keloid scarring following median sternotomy: a case study. J Cardiothorac Surg. 2010;5:122. doi: 10.1186/1749-8090-5-122. [ PMC free article ] [ PubMed ] [ CrossRef ]
  • Kim DY, Kim ES, Eo SR, Kim KS, Lee SY, Cho BH. A surgical approach for earlobe keloid: keloid fillet flap. Plast Reconstr Surg. 2004;113:1668–1674. doi: 10.1097/01.PRS.0000117199.47891.4F. [ PubMed ] [ CrossRef ]
  • Ogawa R, Yoshitatsu S, Yoshida K, Miyashita T. Is radiation therapy for keloids acceptable? The risk of radiation-induced carcinogenesis. Plast Reconstr Surg. 2009;124:1196–1201. doi: 10.1097/PRS.0b013e3181b5a3ae. [ PubMed ] [ CrossRef ]
  • Chang CH, Song JY, Park JH, Seo SW. The efficacy of magnetic disks for the treatment of earlobe hypertrophic scar. Ann Plast Surg. 2005;54:566–569. doi: 10.1097/01.sap.0000152529.02954.07. [ PubMed ] [ CrossRef ]
  • Savion Y, Sela M, Sharon-Buller A. Pressure earring as an adjunct to surgical removal of earlobe keloids. Dermatol Surg. 2009;35:490–492. doi: 10.1111/j.1524-4725.2009.01074.x. [ PubMed ] [ CrossRef ]
  • Al-Attar A, Mess S, Thomassen JM, Kauffman CL, Davison SP. Keloid pathogenesis and treatment. Plast Reconstr Surg. 2006;117:286–300. doi: 10.1097/01.prs.0000195073.73580.46. [ PubMed ] [ CrossRef ]

Articles from Journal of Cardiothoracic Surgery are provided here courtesy of BioMed Central

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Page contents

  1. What are keloid scars?
  2. Who gets keloid scars?
  3. Can you prevent keloid scars?
  4. Treatments for keloid scars

Keloid scars

A keloid scar on the back of a man's head

Credit:

Alamy Stock Photo

Some scars grow lumpy and larger than the wound they’re healing – this is called keloid scarring.

Anyone can get a keloid scar, but they’re more common in people with dark skin, such as people from Africa and African-Caribbean and south Indian communities.

What are keloid scars?

When the skin is broken – for example, by a cut, bite, scratch, burn, acne or piercing – the body produces more of a protein called collagen.

Collagen gathers around damaged skin and builds up to help the wound seal over.

The resulting scar usually fades over time, becoming smoother and less noticeable.

But some scars don’t stop growing, invading healthy skin and becoming bigger than the original wound.

These are known as keloid scars, which affect around 10-15% of all wounds.

Keloid scars are more common on the upper chest, shoulders, head (especially the earlobes) and neck, but they can happen anywhere.

They’re normally:

  • shiny
  • hairless
  • raised above surrounding skin
  • hard and rubbery
  • red or purple at first, before becoming brown or pale

They can last for years, and sometimes don’t form until months or years after the initial injury.

They’re usually painless, but some can cause:

  • pain
  • tenderness
  • itchiness
  • a burning feeling
  • limited movement if located on a joint

Some people feel embarrassed or upset if they think the scar is disfiguring them.

Experts don’t fully understand why keloid scarring happens. They’re not contagious or cancerous.

Keloid scars can sometimes develop after minor skin damage, such as burns, acne scars and even chicken pox, but they can sometimes happen spontaneously with no history of skin trauma.

If you have had a keloid scar before, you’re more likely to get another.

Who gets keloid scars?

Keloid scars can affect anyone, but they’re more common in people with dark skin and it’s thought they may run in families.

Younger people between the ages of 10 and 30 are more likely to develop them.

Can you prevent keloid scars?

You can’t completely prevent keloid scars, but you can avoid any deliberate cuts or breaks in the skin, such as tattoos or piercings, including on the earlobes. 

Treating acne will reduce the likelihood of acne scars appearing.

Avoid minor skin surgery to areas more prone to keloid scarring (the upper chest, back and upper arms) if possible.

Treatments for keloid scars

There are several treatments available, but none have been shown to be more effective than others. Treatment can be difficult and isn’t always successful.

Treatments that may help flatten a keloid include:

  • steroid injections
  • applying steroid-impregnated tape for 12 hours a day
  • applying silicone gel sheeting for several months

Other options include:

  • freezing early keloids with liquid nitrogen to stop them growing
  • laser treatment to reduce redness – but this won’t make the scar any smaller
  • surgery, sometimes followed by radiotherapy, to remove the keloid – although the keloid can grow back and may be larger than before

If you’re bothered by a keloid scar and want help, see your GP.

Media last reviewed: 18/02/2018

Media review due: 19/02/2021

Page last reviewed: 20/06/2016
Next review due: 20/06/2019

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  3. Cure for keloid on chest

Cure for keloid on chest

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8 years back Keloids scars develops on my chest, they look ugly. Can you please prescribed medicine for this.


Asked for Male, 45 Years


1218 Views

v


doctor profile image

Dr. Atula Gupta

Dermatologist/Cosmetologist | Gurgaon

1/2
people found this helpful

Keloid:-
Not to be removed surgically as changes of recurrence are there.
An injection to be given inside the lesion over chest once in 3 weeks(Injection Kenacort 40mg/ml) once in 3 weeks.
To be given

…  Read More

I have keloid problem.
After age of 26 I had problem of keloid.
I have developed it on my chest and shoulders majorly.
Q.What could be the reason..?
What to avoid..?
What precautions to be taken..??
Does Keloid has permanent solution.?can it be removed..?

Regards,
Vishal Pawar


Asked for Male, 33 Years


1101 Views

v


doctor profile image

Rajitha Gujjari

Dermatologist | Hyderabad

4/6
people found this helpful

Hi…..
Keloid is due to abnormal healing process. To avoid keloid formation injuries should be avoided. There are many options for treating keloid like ILS; cryotherapy; lasers,ect.The mode of therap

…  Read More

When i was teenager i used to have so many pimples all over my face, back, arms and chest. Due to my immaturity i hv popped so many of them. Because of that i m left with so many keloids on my breast. I regret it too much. I find no way out to cure it. I m very much worried.


Asked for Female, 23 Years


500 Views

v


doctor profile image

Dr. Asmita Dhekne Chebbi

Dermatologist | Bangalore

Sometimes, acne on the chest, back can heal to form hypertrophic scars/ keloids. Treatment options for them include lasers and intralesional injections. Please visit a dermatologist for the same

…  Read More

Im having keloid on chest very itching…
Painfull …i looking for treatment…it is increasing in size..


Asked for Male, 32 Years


481 Views

v


doctor profile image

Dr. A.P Aparna

Homoeopath | Hyderabad

Depending on size,keloids r treatable either with medicines r surgery.Though once if u hav underwent surgery(if required),then for controlling recurrence,need T/t furthr.Can b suggested only after che

…  Read More

Hello sir/ma’am
I was operated in August for subcutaneous intestinal adhesion. Currently my scar has keloid formation. I was applying graphitis which is an ointment that treats keloids. But there hasn’t been much change.
Are keloids dangerous? What do I do?


Asked for Female, 21 Years


458 Views

v


doctor profile image

Dr. B K Madhusudan

Homoeopath | Bangalore

3/3
people found this helpful

Hi
I am a consultant Homoeopath from bangalore.
Keloids are the unnaturally growing scar tissue.
Occasionally it gives pain.
Graphitis is one of the many remedies for keloids.
Each individual nee

…  Read More

Keloid scar tissue formation on both ears piercing area for studs since last 10 years and tried cosmetic injections from cosmoclinic dubai and speciality clinic in kochi. no permanent cure or reliefs.


Asked for Female, 22 Years


256 Views

v


doctor profile image

Dr. Anil Kumar Jain

General Physician | Bangalore

1/1
people found this helpful

Hello there.
I can understand your concern.
Yes. Keloids are notorious in that way.
Usually some injections can be done in the keloid to reduce it, but sometimes it doesn’t work or even re occurs

…  Read More

Suffering from keloid from 8 years.
Can it be cured.
Please suggest me some more information.
Fed up with this disease


Asked for Male, 32 Years


183 Views

v


doctor profile image

Dr. Manoj Agarwala

Dermatologist | Delhi

Thanks for the query.
Keloid is a difficult medical condition to treat completely.
The most common reason to have keloid is after a skin trauma and the risk increases many-folds if other family member

…  Read More

I m suffered from keloids at last eight years please tell me best doctor in my area or out my area my problem is very critical please please please…


Asked for Male, 30 Years


179 Views

v


doctor profile image

Dr. Venu Kumari

Dermatologist | Hyderabad

u need to undergo CO2 laser

…  Read More

I have Keloid in my body and it grow day by day what should i do to it, so that i could rid out of it.


Asked for Male, 22 Years


171 Views

v


doctor profile image

Dr. Geetika Bansal

Homoeopath | Delhi

0/1
people found this helpful

Keloid is a very slowly progressively growing tissue. Homeopathy can stop its growth in just few doses.
To regress the size of keloid, is a slow process.
Longer treatment is required.

…  Read More

I have been having keloids on my chest since more than 5 years now. I tried the allopathic route where doctor tried Cryotherapy along with steroid injections directly on the keloid. It seemed to reduce the size. Then I used silicon gel sheets on the keloids for an year.

Now again I have 5-7 keloids on the same area and the earlier treatment just s


Asked for Male, 31 Years


170 Views

v


doctor profile image

Dr. Manoj Agarwala

Dermatologist | Delhi

1/1
people found this helpful

Thanks for the query.
Keloid is a difficult medical condition to treat completely. The most common reason to have keloids is after a skin trauma in predisposed sites such as shoulders, chest and elbow

…  Read More

Disclaimer : The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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