Keloid

Keloid is characterized by the growth upon the skin of one or more rounded or oval, flat, smooth-surfaced tumors of varying size, from the margins of which irregular projections are frequently met with.

The development and progress of the affection is chronic, and is attended with but little pain or other inconvenience. The color of the skin is in some cases little changed, while in others it becomes paler and even completely, blanched, like that of ordinary scar tissue.

The affection is said to arise spontaneously, and at other times at the site of some traumatism or wound of the skin; and the terms true and false keloid have been applied to these two forms, which are to be distinguished only by their etiology.

Vidal reports the case of a 53 year old man in whom a keloid, nine centimeters long, three centimeters wide and one centimeter high, developed spontaneously in the sternal region. He did not have syphilis and no discoverable cause could be found. At first it increased in size; but slowly; since 1878, however, it grew more rapidly and became painful. A second keloid has lately developed in the flexure of the right elbow, also without visible cause.


We know, however, that keloid may arise from even the minutest wounding of the skin, as from the prick of a pin or lancet point.

Amicus reports the case of a young nervous woman who, from childhood, suffered from nervous symptoms. One year before coming under his observation she was attacked with a symmetrical eruption on the trunk and lower extremities, showing 318 keloids, the size of millet seeds. The lymphatics were normal; the urine showed nothing wrong. During her sojourn in the hospital she had several convulsions, retention of urine, etc. These so-called keloids were small pinkish elevations on the skin, which might be mistaken for sarcomata. No trauma preceded the trouble.


Mr. Hutchinson mentions some rare forms of keloid, in which he details several interesting cases, with the following conclusion:

1. That with keloid, as with other skin diseases we must not expect too close a conformity to the type form.
2. That for clinical convenience, we may recognize several varieties of keloid, the prognosis as to spontaneous disappearance and proneness to return after excision differing much in each.
3. That the first and most typical is that in which keloid begins in very small, perhaps forgotten, scars, and slowly spreads far beyond their limits into sound skin. In most cases, the extension and duration are indefinite; and the hardness, glossiness, abruptness of outline, etc., are always well marked. The pxoneness to recur very quickly after excision is very great in these.
4. That in the second group, in which keloid growth begins in the middle of large scars, such as those of burns, it is seldom so well characterized. It often does not extend beyond the scar, and often, especially in young persons, soon begins to soften again, and to gradually disappear.
5. That in a third form the keloid growth is deeper, never produces the glossy, superficial, elevated, and spurred patches which occur in the others. These cases are very slow, and show but little tendency to spontaneous disappearance. They do not develop in connection with large scars, but rather with inflammatory damage to the skin. They are less prone than the others to recur after excision.
6. That  although  definite  scars   almost  invariably  precede the formation of keloid, yet that there   are   allied conditions which result rather from inflammation after injury, than from varying which is demonstrable as cicatrix.
7. That the cases of multiple keloid prove either that there is in some persons a remarkable tendency to the disease, or that primary patches have the power of infecting the blood and producing others.
8. That there is little or no clinical proof of tendency on the part of keloid to pass into cancer.