From the Guidelines
Keloids are more common in individuals of Afro-Caribbean descent due to genetic predisposition. People with darker skin, particularly those of African, Caribbean, and Asian ancestry, have a higher risk of developing keloids compared to individuals with lighter skin, as noted in studies on body modification methods such as tattooing, piercing, and scarification 1. This increased susceptibility appears to be linked to specific genetic variations that affect collagen production and regulation during wound healing.
Key Points
- In Afro-Caribbean populations, there is evidence of familial clustering of keloids, suggesting an autosomal dominant inheritance pattern with incomplete penetrance.
- The exact genetic mechanisms involve abnormal fibroblast activity, excessive collagen deposition, and altered inflammatory responses during wound healing, which can be triggered by body modification processes that puncture the skin, as advised against by pediatricians for adolescents with a history of keloid formation 1.
- Certain areas of the body such as the chest, shoulders, earlobes, and upper back are particularly prone to keloid formation in susceptible individuals.
- Understanding this genetic predisposition is important for preventive strategies in high-risk populations, including careful consideration before elective procedures like ear piercing or tattoos, and prompt treatment of wounds to minimize keloid development, with teenagers being cautioned about the risk associated with scarification and other body modification processes if they have a personal or family history of keloids 1.
From the Research
Keloid Formation in Afro-Caribbean Population
- Keloid formation occurs with increased incidence in African Americans and Afro-Caribbeans compared to other ethnic populations 2.
- The reason for this racial difference is not known, but trauma, foreign-body reactions, infections, and endocrine dysfunction have been proposed as precipitating factors 3.
- Keloids are found most commonly on the ear lobes, shoulders, upper back, and midchest, and extend past the area of trauma 3.
Treatment Modalities for Keloids
- Various treatment modalities have been used to treat keloids, including corticosteroids, surgical excision, topical silicone gel sheeting, laser therapy, cryotherapy, photodynamic therapy, and radiotherapy 4.
- Silicone gel sheeting has been shown to reduce the incidence of hypertrophic scarring in people prone to scarring, and to improve scar thickness and color 5.
- Current literature supports silicone gel or sheeting with corticosteroid injections as first-line therapy for keloids, with adjuvant intralesional 5-fluorouracil (5-FU), bleomycin, or verapamil as possible additional treatments 6.
Recurrence Rates of Keloids
- The recurrence rates of primary and secondary keloids have been reported to be 43% and 58%, respectively 2.
- Treatment modalities such as keloid excision with intraoperative triamcinolone injection, and keloid excision with a combination of intraoperative triamcinolone injection and postoperative radiation, have been shown to have lower recurrence rates compared to other treatment protocols 2.
- Silicone sheeting and pressure therapy have also been shown to reduce keloid recurrence 6.