Involvement of scalp skin is fairly uncommon and occurs in about 5% of all patients with keloid disorder. Scalp involvement is strikingly gender and race specific, and more commonly seen among Africans/African American men.
Involvement of scalp as the only site of keloid disorder is uncommon. About two thirds of patients have keloid lesions elsewhere on their skin. Like other keloids, the clinical presentation, size and shape of skin lesions of scalp vary from patient to patient. Scalp keloid lesions in their early stages appear as small raised spots, and are few in number. As time passes, the lesions grow in size and spread to involve a larger area of the scalp. There are three distinct patterns of scalp involvement with the keloid process.
- Occipital keloids with acne keloidalis as a major component, presenting with papules in occipital area and upper neck.
- Keloid involvement of scalp without acne component leading to formation of typical keloid nodules and tumors that are also seen elsewhere on the skin.
- Massive scalp keloids that only seen among those who have had prior scalp keloid removal surgery.
Widespread and massive keloid formation in the occipital scalp area. Notice massive keloid tumor formation which is the result of prior surgeries to remove the scalp keloids. Proper treatment of this case, at this stage, will require multiple rounds of cryotherapy, given once every month to remove this keloid mass.
Scalp keloid in a young African American Male. This patient has had several treatments, including surgical removal of this keloid, but continued to have to deal with keloid regrowth, oozing, infection from the keloid. Notice presence of several small keloid lesions in the periphery of the main lesion
Treatment of Scalp Keloids:
Treatment of scalp area keloids has to be planned very carefully to accommodate for the type, size and location of keloid lesions. General principles of keloid treatment apply to these keloids as well. Surgery quite often results in worsening of these keloids and should be avoided in all patients.. Radiation therapy should also be avoided, as it for sure will put the patients at risk for development of cancer. All scalp keloids should be treated with medical means only. Most patients will require protracted course of treatment, which will incorporate topical cryotherapy for bulky lesions, topical steroid lotions for very small and papular lesions, and rarely steroid or chemotherapy injections into the keloid lesions.