Facial Keloids – General Information:
Keloid involvement of the face obviously has a major impact on the person's psyche and is a known cause for psychosocial anxiety. This impact is real, even for those with the smallest of facial keloids. The impact is much greater in patients who have more noticeable and larger facial keloids. The impact is not only felt by person who has facial keloid, but also by others who come to see the keloid.
The patient who has a facial keloid may feel inadequate or have low self-esteem. The person who comes to see someone with facial keloids, on the other hand, may feel uncomfortable or may feel bad for the victim of this disorder.
The impact of facial keloids goes beyond interpersonal relationships. The impact can be felt during a job interview, whereby a hiring manager, he/she may think twice before hiring someone with noticeable facial keloids.
Facial keloids are equally seen among both genders and all races, but are more common among Africans, African Americans and Asians as opposed to Caucasians. Although facial keloids are seen in the individual from all races and ethnic backgrounds, tumoral and massive facial keloids are almost exclusively seen among Africans/ African Americans, and often in those who have had prior keloid removal surgery. Facial keloids among whites and Asians usually do not evolve to become tumoral. This is perhaps due to genetic differences that lead to the development of keloid disorder.
Great majority of patients who present with facial keloids also have keloids elsewhere in their body. In men who have facial keloids, the lesions grow over time and involve wider areas of the skin. Also, facial keloids may become infected and become a source of chronic purulent discharge. Ingrown hair, either within the mass of keloids or on the edges of facial keloids are common source of keloid infections.
Contrary to the belief, and practice of some plastic surgeons, facial keloids should never be removed surgically as it often results in worsening of these keloids and should be avoided at all costs. Medical treatment of facial keloids that reoccur after surgery can become quite complicated and rather be challenging.
Papular/Linear Keloids of White Skin:
These keloids often develop at a younger age, often in teenagers and among Asians or Caucasians. These keloids are often triggered by acne. Most these patients have other keloid lesions elsewhere on their skin. Some of these patients suffer from mild form of the disorder, and over time develop only few keloid papules, or nodules, on their face as well as their chest, shoulders or upper arms. Some others have the more severe form of the disorder and develop numerous skin lesions over time. Although the genetics of keloid disorder remains unknown, it is quite plausible to hypothesize that the genetics of the disorder is quite variable among different ethnic groups, and always more severe among Africans/African Americans and those with black skin.
Treatments of facial keloids:
In treating facial keloids, Dr. Tirgan follows
Treatments of facial keloids have to be planned very carefully. General principles of keloid treatment apply to facial keloids as well. With the very high rate of recurrence and risk of worsening of keloids after surgery, all facial keloids have to be treated medically. Surgery and radiation therapy should be avoided in all patients.
Treating facial keloids, much like other keloids, can be challenging and time-consuming. Patience and perseverance are the two most important factors in achieving successful treatment results. Treatment of facial keloids has two phases:
Recurrent facial keloid
Recurrent facial keloid after surgical removal of a primary facial keloid in a young African female with no other keloid lesions elsewhere. This young patient had a direct trauma that resulted in a laceration on her face, which was sutured. The wound soon evolved into a keloid, which was then removed surgically. Dense keloid tissue started forming soon after the surgery.
Linear Facial Keloid
Keloid formation over the longitudinal scar of surgery. This patient had previously sustained an injury to his face that caused the formation of a primary keloid which was subsequently removed surgically. Secondary keloid formed along the line of prior keloid surgery. Notice keloid tumor formation on both ends of his keloid. This patient also has heavy scaring over another surgical wound on his trunk.