Diagnosis: Keloid
Keloids on arms caused by sulfuric acid. World War 2. 20th General Hospital.. Clinical photograph sourced from Wikimedia Commons (CC BY 2.0). Attribution: Otis Historical Archives of “National Museum of Health Medicine” (OTIS Archive 1).
Firm, smooth, rubbery, shiny, raised scars extending beyond the wound border. Often pruritic or painful. Predilection sites: earlobes, chest, shoulders, upper back. Color ranges from flesh-colored to red to dark brown. May continue to grow over years.
Often follows trauma, surgery, piercings, burns, acne, or vaccination. More common in ages 10-30 and in patients of African, Asian, and Hispanic descent. Family history is common (autosomal dominant with variable penetrance).
Intralesional triamcinolone (first-line, 10-40 mg/mL). Combination: excision + immediate post-op radiation or triamcinolone. Silicone sheets/gel. Cryotherapy. Pressure earrings post ear keloid excision. 5-FU intralesional injections.
Hypertrophic scar, Dermatofibrosarcoma protuberans, Dermatofibroma, Morphea
Keloids extend BEYOND original wound borders (distinguishes from hypertrophic scars). Surgical excision alone has 50-100% recurrence rate — always combine with adjuvant therapy. Prevention in high-risk patients: pressure garments, silicone sheeting, avoid elective procedures.
Tags: keloid, scar, fibroproliferative, wound healing