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
 Pressure Therapy

 Diminishes size and induration (HTS >Keloid) when

used as monotherapy
 <10% Recurrence when combined with surgery

Photos Courtesy of Dr. Redett

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