Keloids

Diagnosis: Keloids

Multiple raised, firm plaques and nodules on back.

Clinical Presentation

Multiple raised, firm plaques and nodules on back.

Clinical History

Submitted by Alaa Saad. Originally posted September 28, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Hypertrophic scar • Dermatofibrosarcoma protuberans • Dermatofibroma • Lobular capillary hemangioma • Foreign body granuloma

Key Learnings

• Key distinction from hypertrophic scar: keloids extend BEYOND the boundaries of the original wound • Higher prevalence in individuals of African, Asian, and Hispanic descent • Common locations: earlobes, chest, shoulders, upper back • Genetic predisposition — family history is a significant risk factor • Histology: thick, hyalinized collagen bundles ("keloidal collagen") with minimal cellularity • Recurrence rate is high after excision alone (~50-80%) — multimodal treatment is key • Prevention: avoid unnecessary procedures in keloid-prone patients

Tags: keloids, alaa saad