Keloid may be a modern inflammatory disease: A historical and clinicopathological perspective

Keloid is a fibroproliferative skin disorder characterized by chronic inflammation and growth beyond the original wound margins. Recent research indicates that it is driven by systemic inflammation and vascular dysfunction. This led us to speculate that keloid may be a modern inflammatory disease, similar to hypertension, diabetes, and atherosclerosis. To test this, the historical medical literature was examined for keloid descriptions. Specifically, medical databases, including PubMed, were searched in English, Chinese, and Japanese using the terms "keloid," "hypertrophic scar," "scar," "scarification," and "Alibert." Relevant published medical textbooks were also reviewed. Forty-five articles describing ancient Egyptian, Chinese, Indian, and European medical texts and early-modern Chinese and European medical compendia were retrieved. These texts showed that although records preceding the 16th century described and even distinguished between scars and hypertrophic lesions, none described spreading scars. In the 16-18th centuries, Chinese medical compendia mentioned "extending," "painful," and "numb scars" for the first time. In 1816, a French physician clearly described keloids. Descriptions and depictions of keloid increased markedly thereafter. Thus, the historical evidence suggests that keloid was rare until ∼300 years ago. This coincides with the industrial and post-industrial period, which was associated with dramatic cultural, environmental, and societal changes and expansion of modern inflammatory diseases such as atherosclerosis. Our findings and the fact that keloid is a systemic inflammatory disease suggest that keloid may also be a modern disease.