Keloids: clinical challenges and treatment strategies

Abstract

Keloids are abnormal scars that result from a hypertrophic skin response to trauma, such as cuts, burns, or surgeries, leading to excessive growth of fibrous tissue that extends beyond the boundaries of the original wound. These scars are more common in individuals with darker skin and have a significant genetic basis, indicating that familial predisposition may influence their development. The etiology of keloids is multifactorial, involving genetic, immunological, and environmental factors. Mutations in genes related to collagen metabolism and wound healing are often observed, as well as overexpression of pro-inflammatory cytokines that may perpetuate the formation of excessive scar tissue. The diagnosis of keloids is primarily clinical, based on the characteristic appearance of the lesion and the patient’s history, but can be complemented by histopathological examinations that reveal a dense deposition of collagen in the reticular dermis. Various therapeutic approaches are used, such as surgical excision, intralesional corticosteroid injections, radiotherapy, laser treatments, and cryotherapy. However, the recurrence rate is high, making the management of keloids a constant clinical challenge. The development of new therapeutic strategies and research into emerging treatments, such as laser therapy and the use of interferons, is underway to improve long-term outcomes. The choice of the ideal treatment depends on multiple factors, including the location, size of the lesion, and previous response to therapy, highlighting the need for a personalized approach for each patient.