[Keloid scars on black skin: myth or reality]

Area of Science:

• Dermatology
• Pathology
• Surgical Oncology

Background:

• Keloid scars result from excessive type I collagen accumulation in the dermis.
• They exhibit high morbidity due to frequent and unpredictable recurrences.
• Keloids disproportionately affect individuals of Black African and Asian descent.

Purpose of the Study:

• To analyze treatment outcomes for 149 keloid cases.
• To discuss the clinical presentation and management of keloids, especially in darker-skinned individuals.

Main Methods:

• Retrospective analysis of 98 patients treated for 149 keloid tumors between 1990 and 2011.
• Evaluation of patient demographics, etiologies, scar locations, and presenting symptoms.
• Surgical interventions included total excision (TE) with skin grafting and intrakeloid excision (IKE) with intra-lesional steroids.

Main Results:

• The study included 78 adults and 20 children, with a higher prevalence in women (65.3%) and Black individuals (96%).
• Trauma was the leading cause (63.1%), with keloids most commonly occurring on the head (56.4%) and ears (25.5%).
• Recurrence rates were high (100%), influenced by complications, with aesthetic concerns and pain being primary reasons for consultation.

Conclusions:

• Keloids are biologically heterogeneous, with higher prevalence in darker-skinned populations.
• Treatment outcomes are still under evaluation.
• The most effective prevention strategy is avoiding scar formation altogether.