Face Keloids among African Americans:
Most facial keloids among black skin individuals are triggered by ingrown hair. Most patients have other keloid lesions elsewhere on their skin. Some patients suffer from mild form of the disorder, and over time only develop few keloid papules or nodules on their face; as well as their chest, shoulders or upper arms. Others have more severe form of the disorder and over time, develop numerous large skin lesions on face or other parts of their skin.
Primary Nodular/Tumoral Facial Keloids:
Continuous growth of nodular keloids in individuals with black skin will lead to formation of large and tumoral keloids. These keloids are race specific and are only seen among Africans, African Americans and in those with Black skin. This phenotype is most likely due to a unique genotype that is not only different from milder forms of keloid disorder, but also nonexistent among Caucasians and Asians. Although uncommon on the face, presence of tumoral keloids on the face results in constant anxiety and depression.
Aftermath of Surgery:
Treatment of facial keloids, much like most other keloids should be limited to medical treatments, utilizing topical cryotherapy and intra-lesional injection of steroids, or chemotherapy drugs. As you will notice here, the most severe cases of facial keloids are seen in individuals with black skin who have undergone surgery for removal of their facial keloids. Surgery is almost exclusively performed on Africans/African Americans in order to remove facial keloid lesions.
Better understanding of the underlying genetics and patho-physiology of keloid disorder should dissuade surgeons from performing surgery, not only on facial keloids, but also on any kind of keloid lesion.
Severe Facial Keloids:
Severe and extensive facial keloids are not only race specific, but more importantly, they are Iatrogenic. The worst cases of facial keloids are exclusively seen in Africans, African Americans who have had prior keloid surgery (ies) for treatment of facial keloid, much like other patients with massive keloids elsewhere in their body. As stated earlier in this book, keloids should not, and cannot be treated with surgery. A great number of keloid patients are simply harmed by surgery, especially those who have keloids elsewhere on their skin.