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Patient Case: Keloids

Patient Case: Keloids

Discussion

A 28-year-old woman presents to a dermatologist with a raised, itchy, and firm scar on her right earlobe, which developed after she had her ear pierced one year ago. She initially noticed a small bump at the piercing site, but over the past several months, it has continued to grow beyond the original wound. She reports occasional pain and itching but denies any discharge or infection.

On examination, a firm, rubbery, and shiny overgrown scar, measuring 2 cm in diameter, is seen on the earlobe. The lesion extends beyond the initial wound margin and has a smooth, hyperpigmented surface. The patient has no history of hypertrophic scars, but she mentions that a relative also has similar scars.

The physician diagnoses a keloid, a benign overgrowth of scar tissue. The patient is counseled on treatment options, including intralesional corticosteroid injections, laser therapy, and surgical excision with recurrence prevention strategies.

Questions
  1. What is the most likely diagnosis in this patient?
    a) Hypertrophic scar
    b) Keloid
    c) Epidermoid cyst
    d) Dermatofibroma
  2. Which of the following best differentiates a keloid from a hypertrophic scar?
    a) Keloids remain within the wound margins, while hypertrophic scars extend beyond
    b) Keloids extend beyond the original wound, while hypertrophic scars remain within the wound margins
    c) Keloids always regress over time, while hypertrophic scars persist
    d) Keloids are more common on the palms and soles
  3. What is the first-line treatment option for keloids?
    a) Surgical excision alone
    b) Intralesional corticosteroid injections
    c) Oral antibiotics
    d) Cryotherapy alone
  4. Which factor is most associated with an increased risk of keloid formation?
    a) History of sunburns
    b) Personal or family history of keloids
    c) Use of topical steroids after injury
    d) Frequent moisturizing of the skin
Reveal answers

Answers

  1. (b) Keloid
    • The patient presents with a firm, raised, itchy scar that extends beyond the original wound after an ear piercing, which is characteristic of a keloid. Unlike hypertrophic scars, keloids continue to grow beyond the wound margins.
  2. (b) Keloids extend beyond the original wound, while hypertrophic scars remain within the wound margins
    • Hypertrophic scars may be raised but stay within the boundaries of the injury, whereas keloids spread beyond the original wound site and continue to grow.
  3. (b) Intralesional corticosteroid injections
    • Steroid injections (e.g., triamcinolone) are the first-line treatment for keloids, helping reduce inflammation, flatten the scar, and relieve symptoms. Surgical excision alone has a high recurrence rate and should be combined with other w(b) Personal or family history of keloids
    • Genetic predisposition plays a major role in keloid formation. Individuals with a family history or a previous keloid are at a higher risk of developing keloids after trauma or surgery.