What factors exacerbate sternal keloid formation?

From the Guidelines

Sternal Keloid Exacerbation Factors

Sternal keloid formation can be exacerbated by personal or family history of keloids 1.

• A history of keloids is a significant risk factor, as it indicates a predisposition to keloid formation 1.
• Other factors that may contribute to the exacerbation of sternal keloids include infections, which can be treated with standard topical or systemic antibiotic agents 1.
• Additionally, mechanical stress and hormonal fluctuations may also play a role in the worsening of sternal keloids, although the provided evidence does not directly support this 1.
• It is essential to note that scarification and other body modification processes can increase the risk of keloid formation, particularly in individuals with a personal or family history of keloids 1.
• As such, it is crucial to caution teenagers with a history of keloids about the risks associated with these processes 1.

From the Research

Factors Exacerbating Sternal Keloid Formation

• Tension load in the anterior chest area due to frequent movements of the upper limbs and respiratory movements, which stretches the skin horizontally and imposes cyclical tension on wounds, exacerbating and prolonging inflammation in the reticular dermis 2
• Folliculitis and acne, which are common on the anterior chest and can trigger the development of keloids 2
• Oily skin, which can lead to increased sebum production and abnormal sebum secretion, contributing to keloid recurrence 3
• Genetic predisposition, with certain ethnic populations such as African Americans and Afro-Caribbeans being more prone to keloid formation 4

Treatment-Related Factors

• Corticosteroid therapy, which can have side effects including abnormal sebum secretion and acne, leading to keloid recurrence 3
• Surgical excision alone, which can result in high recurrence rates of up to 54% 4
• Inadequate treatment modalities, such as excision alone or excision with postoperative radiation only, which can lead to higher recurrence rates compared to combination therapies 4

Other Factors

• Skin tension, which can induce the growth of keloids along the prevailing lines of skin tension 2
• Wound inflammation, which can be exacerbated by cyclical tension and contribute to keloid formation 2