Description of clinical and histopathological characteristics of keloids in a sub-Saharan African population

Keloids are among the leading benign skin conditions globally, affecting up to 16% of the African population. They are characterized by aggressive behaviour, high recurrence rates and poor treatment outcomes, particularly in African populations. Despite this, most information on keloids in sub-Saharan Africa remains anecdotal, with limited comprehensive studies describing their clinical and pathological characteristics.

To analyse the clinical and histopathological features of keloids in a sub-Saharan African population.

Following ethical approval, 231 participants were enrolled in a cross-sectional study conducted at the 2 national referral plastic surgical centres in Uganda. Data on demographics, clinical presentations and histopathological features of keloids were collected and analysed.

Sixty-four per cent of participants (n = 148/231) were women, 63.3% (n = 133/210) resided in central Uganda and 82.3% (n = 190/231) belonged to the Bantu ethnic group, with those belonging to the Baganda tribe predominating (n = 97/231; 42.0%). Keloids were broadly classified into sessile (n = 116/231; 50.2%) and nodular types. The most frequently affected anatomical sites were the head and neck (n = 106/231; 45.9%) and the trunk (n = 52/231; 22.5%). Additionally, 58.0% (n = 134/231) of participants had multiple keloids. Histopathological analysis of 35 excised specimens revealed that keloids are primarily a dermal disease, characterized by excessive collagen deposition, particularly hyalinized collagen.

Keloids in African populations exhibit a slight female predominance, a tendency toward multiplicity and larger lesion volumes. Histopathological findings highlight excessive collagen deposition as a hallmark, emphasizing the need for tailored approaches to improve treatment outcomes.