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Most cutaneous wounds heal with scar formation. Ideally, an inconspicuous normotrophic scar is formed, but an abnormal scar (hypertrophic scar or keloid) can also develop. A major challenge to scientists and physicians is to prevent adverse scar formation after severe trauma (e.g. burn injury) and understand why some individuals will form adverse scars even after relatively minor injury. Currently, many different models exist to study scar formation, ranging from simple monolayer cell culture to 3D tissue-engineered models even to humanized mouse models. Currently, these high-/medium-throughput test models avoid the main questions referring to why an adverse scar forms instead of a normotrophic scar and what causes a hypertrophic scar to form rather than a keloid scar and also, how is the genetic predisposition of the individual and the immune system involved. This information is essential if we are to identify new drug targets and develop optimal strategies in the future to prevent adverse scar formation. This viewpoint review summarizes the progress on in vitro and animal scar models, stresses the limitations in the current models and identifies the future challenges if scar-free healing is to be achieved in the future.

Unlike many skin disorders discussed in textbooks, keloids have been described in detail dating back to 3,000 bc.1 The Yoruba tribe of Western Africa recorded their knowledge of keloids in painting and sculpture ten centuries prior to modern times.2 Despite this considerable head start, we have made remarkably little progress since the Yorubas toward understanding keloid etiology. This fundamental ignorance is partially responsible for our current lack of consistently reliable, safe treatment, and prevention measures.

Excess scar formation occurs after dermal injury as a result of abnormal wound healing. Hypertrophic scars and keloids both represent fibrotic skin conditions which can be very difficult, even frustrating, to treat. Identification of differences between hypertrophic scars, keloids and normal scars are a prerequisite for finding the correct therapeutical concept. Despite the relatively high prevalence of keloids in the general population, the mechanisms underlying keloid formation are only partially understood. This fact is reflected in the multiple treatment modalities, of which no single treatment has proven to be widely effective. Advances in our understanding of the wound healing process reveal new pathophysiological concepts for keloid formation. Our article presents an overview on physiological wound healing and the pathogenesis of scar formation, differentiates keloids from hypertrophic scars and reviews current hypotheses for keloid formation. This information might assist in deciphering the complexity of keloid pathogenesis and help in the development of an efficacious therapeutical strategy.

OBJECTIVES: To analyze the clinical and molecular features of a distinctive muscular dystrophy in a family of black Creole descent. METHODS: We clinically characterized a four-generation pedigree and performed linkage analysis for all relevant autosomal-dominant muscular dystrophies. RESULTS: Affected family members had minor neurologic dissimilarities from previously reported Bethlem myopathy pedigrees and a high incidence of keloid formation. Multipoint linkage analysis traced the family's disease to the region of the collagen genes COL6A1-COL6A2. CONCLUSIONS: We report that Bethlem myopathy was linked to the collagen VIA1-2 region on chromosome 21q22.3 in a black Creole family. This is the first report of molecular-proven Bethlem myopathy in a family of either Creole or African-American descent. Although the correlation of Bethlem myopathy and keloids was not statistically significant, the possible connection between these two abnormalities raises the possibility of a common pathophysiological link involving collage VIA.

Nine women between the ages of 22 and 56 years underwent cosmetic surgery for correction of the severe cutaneous stigmata of pseudoxanthoma elasticum (PXE). The outcome was generally favorable, and follow-up for up to 15 years showed only moderate regression of the skin manifestations. No serious intraoperative or postoperative complications occurred, although tissue friability, poor wound healing, and keloid formation were noted in a minority of persons. An unexpected problem of extrusion of calcium particles through the surgical wound occurred in two individuals. This resulted in delayed healing and unsightly scars.

Keloid formation occurs as a result of abnormal wound healing. Despite the high prevalence of keloids in the general population, they remain one of the more challenging dermatologic conditions to manage. More than a cosmetic nuisance, they are often symptomatic and can have a significant psychosocial burden for the patient. Although multiple treatment modalities exist, no single treatment has proven widely effective. In fact, recurrence following treatment is generally the norm. Combination therapy is likely the optimal strategy. In this review, we highlight the clinical features, pathophysiology and management of keloids.

Treatment of keloids can be diverse and, frequently, in cases of recurrence, patients are referred for postoperative radiation therapy. Some sites known for keloid formation, such as the postauricular surface, can create a technical challenge. Because of the need for treatment so soon after surgery, physical manipulation of the freshly operated area to accommodate exposure for electron (or other) therapy is difficult. We were recently asked to evaluate a patient requiring treatment of both postauricular spaces. Literature describing techniques for such a case is scant, and we felt it would be helpful to describe and depict our setup and treatment course.

PubMedID: 16998325 Gynecomastia is an excessive development of the male breast. Surgery is the accepted standard method for treatment.In our department, 5 male patients ranging in age from 18 to 24 years who had grade I-IIA-IIB gynecomastia according to Simon's classification were operated on with a lighted retractor-assisted transaxillary approach. Dissection, excision, and hemostasis were performed under direct vision by using the lighted retractor. The glands and adjacent fat were removed en bloc. The axillary scar was barely visible. The patients were satisfied with the results.Gynecomastia correction with a lighted retractor-assisted transaxillary approach is feasible for those who have grade I-IIA-IIB gynecomastia according to Simon's classification and also for those who do not want to have scars on their breasts' esthetic units and have a tendency towards keloid formation. Scars can be kept in the hidden area, with no considerable complication. The lighted retractor facilitates the transaxillary approach and provides appropriate dissection, excision, and hemostasis. Copyright © 2006 by Lippincott Williams & Wilkins.

Summary Background The excessive accumulation of extracellular matrix is a hallmark of many fibrotic diseases, including the hypertrophic scar and keloid. Recent reports from this research team had shown that exogenous nitric oxide (NO) participates in the keloid formation; however, its role on the synthesis of fibrotic factor (TGF-β1, TIMP-1 and HSP47) in the keloid fibroblasts (KF) remained unclear. Objective In this study, to better define the potential effect of exogenous NO on the expression of fibrotic factors in KF, the enhancing effect of exogenous NO, released from a NO donor, on the synthesis of fibrotic factors in KF was investigated. Methods The seven primary KF cultures were set up to measure the effect of exogenous NO on enhancing the expression of fibrotic factor. Results Elevation of cellular cGMP levels was observed to be induced by NO or blocked by the hydrolysis activity of phosphodiesterase (PDE) by the PDE inhibitor. The elevated levels of cellular cGMP were noted to enhance the expression of TIMP-1 and HSP47 in KF. Exogenous NO was found to significantly accelerate the production of TIMP-1 and HSP47 in the seven primary KFs with a corresponding increase in the production of TGF-β1. Conclusion The results have led to a conclusion, that is: the excess collagen formations in the keloid lesion may be attributed to the NO/cGMP signal pathway by initiating a rapid increase in the expression of TGF-β1, TIMP-1 and HSP47 in the KF cells.

Objective. Keloids occur commonly after trauma to the skin, with ear piercing being a well-known inciting event. We surveyed 32 patients with keloids resulting from ear piercing, to examine a potential relationship between age of piercing and keloid formation. Methods. A total of 32 consecutive patients completed a survey about ear-piercing and keloid formation. Fisher's exact test was used for data analysis. Results. Fifty percent (n = 16) of surveyed patients developed a keloid after their first piercing. Twenty surveyed patients developed keloids with subsequent piercings. Those who had piercings at ≥11 years of age were more likely to develop keloids (80%) than were those who had piercings at Conclusions. Keloids are more likely to develop when ears are pierced after age 11 than before age 11. This observation holds true for patients with a family history of keloids. Given the difficulty and cost of treating keloids, prevention remains the best approach. Patients with a family history of keloids should consider not having their ears pierced. If this is not an option, then piercing during early childhood, rather than later childhood, may be advisable. Primary care physicians and pediatricians should educate children and their parents about the risk of keloid formation.

Keloids are a proliferative ailment of fibrous tissue secondary to dysregulation in various wound healing processes [1]. The diverse phenotypes and multitude of factors that trigger keloid formation have led us to propose "keloid disorder (KD)" as the identifying name for this condition and the term "keloid" to be reserved for referring to each individual skin lesion that patients have. Although benign, KD can cause aesthetic and functional problems, all of which pose a significant negative impact on the individual's quality of life. The earlobes are frequently involved sites for keloid formation following ear piercing, with an incidence of 2.5% [2]. Earlobe keloids are a cosmetic disfigurement that are challenging to treat with a relatively high recurrence rate. The increasing trend toward cosmetic piercing and multiple ear piercing suggests that treating ear keloids will become a more frequent part of plastic surgery practice. Diverse treatment modalities have been introduced with varying degrees of success. Various studies have estimated the onset of the disorder to be between 10 and 30 years of age [3]. We have been faced with several earlobe keloids with earrings embedded within them. A representative case is presented in Figs. 1-​-3.3. Without exception, the cases in the series can be classified as having a sessile-type single nodular pattern based on our novel classification (Chang-Park classification) [4]. We completely excised the keloidal tissue, adopting full thickness wedge excision, which is considered to be the optimal treatment in this morphologic type. The wounds were closed with the appropriate approximation using nylon 5-0 continuous sutures. A compressive wound dressing using hydrocolloid materials and magnets was applied [5]. Following appropriate wound management, the patients were instructed to use the magnets for 12 hours per day for 6 months until the therapy was completed. The purpose of this report is to remind the reader that earrings may be embedded in earlobe keloids. Clinicians should keep this possibility in mind when faced with earlobe keloids. Fig. 1 A right earlobe keloid; sessile-type single nodular pattern based on Chang-Park classification (type II). Fig. 3 Earrings embedded within the earlobe keloids.

The use of nasal septal cartilage for the reconstruction of the orbital floor, following blowout fractures of the orbit is reported. This technique has been employed in a few patients who have been followed up for an average of two years without any complications. This type of reconstruction material has several advantages such as (1) absence of any immunological reactions because of its being autogenous, (2) proximity of the donor site to the site of reconstruction, (3) lending adequate tensile support without adding bulk to the orbital contents and (4) absence of external deformity at the donor site and no possibility of keloid formation in susceptible individuals. Further application and extended follow up are planned.

Keloids present a formidable clinical challenge. Surgical excision in conjunction with radiation therapy may decrease the chance of keloid recurrence. Split-thickness skin grafts, however, are more prone to failure in the setting of radiation. In this report, we present a patient with a recurrent auricular keloid who underwent excision and immediate Integra (Integra LifeSciences, Plainsboro, NJ) application, followed by high-dose rate brachytherapy and interval split-thickness skin graft placement. A 23-year-old woman with a history of a recurrent auricular keloid after previous surgical excision, corticosteroid injection, and radiation underwent reexcision of her keloid. Integra was used to cover the resultant exposed auricular perichondrium. The patient then received high-dose rate brachytherapy (1500 cGy) on postoperative days 1 and 2, followed by definitive split-thickness skin graft placement 3 weeks after her initial surgery. The patient recovered from all interventions without complication. There was no evidence of keloid formation 27 months after the interval split-thickness skin graft placement at either the auricular recipient or thigh donor sites. We report the first case of a 2-stage reconstruction of a recurrent auricular keloid (composed of keloid excision and placement of Integra in conjunction with high-dose rate brachytherapy, followed by interval split-thickness skin grafting), resulting in an acceptable cosmetic result without evidence of recurrence at long-term follow-up.

K eloids are benign overgrowths of scar tissue composed of overproduction of cellular matrix and dermal fi broblasts. As with all genetic diseases, the prevalence of keloids varies between different patient populations, ranging from 0.09% in Great Britain to 16% in the Congo.1 Patients with the genetic predisposition to keloid formation can form large overgrowths following any skin insult.2 In addition to cosmetic concerns and disfi gurement, keloids can also be painful.3 Recurrence of keloids is common despite both medical therapy and surgical removal. Patients on hemodialysis (HD) who are prone to keloid formation present a unique challenge. Multiple studies have shown that the preferred method of access for hemodialysis is via an arteriovenous fi stula (AVF).4 This was further promoted by the Fistula First initiative resulting in an increased prevalence of AVF. During cannulation of the AVF, the skin overlying the fi stula is traumatized, predisposing this population to keloid formation. Further K/DOQI guidelines suggest rotating the site of the needle placement along the AVF to decrease the incidence of pseudoaneurysms.5,6 While the K/DOQI guidelines are benefi cial to the HD population at large, if we generalize to include this unique population, we place them at risk for extensive scarring and keloid formation. To our knowledge, management of HD patients prone to keloids has not been addressed in the literature. We present four cases of patients on HD who developed keloids, and how they were managed. In our centers’ diverse patient population, the incidence of keloids is about 1 in 200.

The keloid scar is a cutaneous mass characterized by nodular fibroblastic proliferation of dermis and a predilection for distinctive anatomical locations. However, keloid extension to neighbouring tissue as a nonsyndromic entity has not been described. In the present report, a case involving a 48-year-old woman with extensive bilateral keloids of the ear lobules and neck following ear piercing is presented.

Earlier studies on the treatment of congenital melanocytic nevi have reported the efficacy of Q-switched ruby laser and Nd:YAG lasers. In this study we evaluated the clinical and the histological effects of a single treatment of normal mode (3 msec) alexandrite laser (755 nm) on small melanocytic nevi.Fourteen patients having 40 nevi entered into the study. Twenty six nevi were clinically followed up after laser treatment for 4 months. Fourteen nevi were biopsied after laser treatment: 8 nevi immediately, 3 nevi after 10 days and 3 nevi after 1 month.At the end of 4 months, 20 (76.92%) nevi attained moderate to significant lightening of color, 5 (19%) nevi had their color matching that of the surrounding skin, one nevus (3.85%) showed very mild hypopigmentation, and 18 (69%) nevi had a surface level similar to the surrounding skin. One nevus healed with keloid formation. Histologically, immediately following laser, there was necrosis of nevus cells in the papillary and uppermost reticular dermis. Nevus cells in the deeper layers of the dermis were not affected. Ten days following laser, the upper dermis showed granulation tissue. One month after laser, there was mild fibrosis in the upper dermis and persistence of nevus cells in the middle and deep dermis.These results suggest that normal mode alexandrite laser may clear or cosmetically improve small melanocytic nevi whether congenital or acquired. However, the concern about the recurrence of the nevi and the potential for malignant transformation should be addressed by long-term follow-up studies.

If the cautery was for hundreds of years an indispensible tool for the physician — and is today used only for hemostasis or the removal of the smallest skin tumors, and in veterinary medicine — so today cryosurgery provides results as effective but at far lower risk.

The interest in the treatment of benign diseases with radiation therapy has grown particularly in the Western part of the world. In 1996, a questionnaire was sent to 1348 institutes worldwide listed in the directory of the Society for Therapeutic Radiology and Oncology asking whether the respondents considered a list of 28 most common benign disorders as being a good indication for orbital radiotherapy.1 Questions concerned the frequency of such treatments and the treatment schedules used. The prevention of keloid formation was the most widely accepted indication, followed by Graves’ ophthalmopathy. Thus, radiotherapy for this orbital disorder is generally accepted and applied worldwide.

Hair transplant surgery is a highly successful procedure for improving alopecia. However, this proce- dure is not without its potential risks and complications. A case of a large keloidal scar following hair transplantation is presented. Those performing hair transplant surgery should be aware of this significant potential complication, especially in Black and Oriental individuals, who are more prone to keloid formation. J Dermatol Surg Oncol 1990; 16:867- 869.

PURPOSE: To report the outcome of photorefractive keratectomy in African Americans, including those with a known history of dermatologic keloid formation. METHODS: A retrospective analysis of African American patients who had photorefractive keratectomy at either of our institutions was undertaken to identify all patients who were at least 3 months status-post refractive surgery. The presence or absence of a history of keloid formation, as well as preoperative and postoperative measurements of uncorrected visual acuity, best-corrected visual acuity, manifest refraction, and the presence and magnitude of any postoperative corneal haze were analyzed. RESULTS: Twelve patients (19 eyes) met the inclusion criteria and three of these patients (six eyes) had a history of keloid formation. Mean uncorrected visual acuity ± SD for the entire study group improved from 20/369 ± 20/270 preoperatively to 20/19.4 ± 20/7.1 postoperatively (average follow-up, 13.8 months). All eyes had postoperative uncorrected visual acuity of 20/40 or better; 14 (74%) achieved 20/20 or better. Mean best spectacle corrected visual acuity went from 20/14.8 ± 20/2.8 preoperatively to 20/15.5 ± 20/3.2 postoperatively (not statistically significant). Mean manifest spherical equivalent was –4.9 ± 3.4 diopters preoperatively and +0.03 ± 0.55 diopters postoperatively. Eight eyes (42%) had trace to 1+ corneal haze following photorefractive surgery. A comparison of postoperative uncorrected and best-corrected visual acuities of known keloid formers with nonkeloid formers revealed no significant statistical difference. CONCLUSIONS: African Americans may have excellent visual outcomes following photorefractive keratectomy. History of keloid formation does not appear to have an adverse effect on the outcome. These results question whether known dermatologic keloid formation should be a contraindication to photorefractive keratectomy.

Polyfibromatosis syndrome is a condition characterized by the occurrence of several cutaneous fibrotic conditions including Dupuytren's contracture and keloid formation. A 10 year follow-up of a patient with an aggressive type of polyfibromatosis associated with erosive arthropathy is presented. The underlying pathogenesis and management of this uncommon condition is discussed.

The basis of keloid formation and its subsequent behavior, the very high incidence of recurrence after resection, and other forms of treatment are not fully understood. Keloids still remain a dilemma in plastic surgery. Analyzing the etiopathogenesis of keloids in a large number of patients in Ghana and in Poland led to a concept of keloid triad hypothesis (KTH). This is defined as a group of three etiologic factors which must simultaneously coexist and interact for keloids to form. The etiological factors are: genetic links; bacterial, viral or any type of infective agent; type of surgery - sutures, tension of suture lines, location of sutures in relationship to the body skin lines of tension; etc. At least three of these factors must be present, inter-correlate, in order to form a keloid. These factors have been sub-divided into two groups - major (or main) and minor (or auxiliary) and are analyzed in this paper. In each situation at least one major factor must be present in order for a keloid to form.

The incidence of keloid formation after burns ranges from 6 to 9%. Numerous methods, e.g. atraumatic excision, irradiation (X-ray), local infiltration of corticosteroids with or without excision and cryosurgery, have been applied for the prevention and treatment of keloids with varying success, since the aetiopathogenesis remains obscure. The basic purpose of the application of certain agents of physical therapy is to prevent development of hypertrophic or keloid scar after treatment of the burn. Besides causing poor aesthetic appearance, keloid scars may endanger joint function. The main object of physiotherapy is therefore to make it possible to maintain the full range of movements and function in the affected joints.

Various types of aberrant wound healing are encountered in surgical practice. Examples include hypertrophic scarring, keloid formation and a range of conditions collectively called the fibromatoses. All these conditions pose problems clinically, and drug treatments for them have yet to be found. It is to the fibromatoses and their possible drug treatment that this study is addressed.

A 32-year-old woman and a 50-year-old man with clinically typical Bethlem myopathy developed seemingly spontaneous keloids on their shoulder region (figure). The patients did not recall any significant trauma to their skin in these regions.

Keloid formation is one of the most challenging clinical problems in wound healing. With increasing frequency of open heart surgery, chest keloid formations are not infrequent in the clinical practice. The numerous treatment methods including surgical excision, intralesional steroid injection, radiation therapy, laser therapy, silicone gel sheeting, and pressure therapy underscore how little is understood about keloids. Keloids have a tendency to recur after surgical excision as a single treatment. Stretching tension is clearly associated with keloid generation, as keloids tend to occur on high tension sites such as chest region. The authors treated 58 chest keloid patients with surgical excision followed by intraoperative and postoperative intralesional steroid injection. Even with minor complications and recurrences, our protocol results in excellent outcomes in cases of chest keloids.

Keloid scar complicating herpes zoster ophthalmicus (HZO) has not been much reported among Africans despite the African population having dark skin. We report on a middle-aged Nigerian with HZO who developed keloid scar following use of traditional herbs to the herpetic rashes. A 52-year-old immune-competent Nigerian male presented with a 2-week history of vesicular rashes involving the left side of the forehead down to the tip of the nose. He initially presented to an African traditional healer who had advised application of various herbs to the lesion. When he presented to the eye clinic, he was treated for the associated uveitis with significant improvement. The cicatricial skin change gradually became raised with clinical appearance of keloid at 1 year of follow-up. Cicatricial skin changes in HZO are not unusual, but keloid formation among Africans has not been much described. Late presentation, use of traditional herbs some of which have corrosive effect and secondary bacterial infection are the possible factors that may encourage such abnormal wound healing. The myth associated with HZO in the local African setting as well as the fact that African traditional healers are still widely accepted among most African communities may play a role in increasing the risk of keloid formation among our population following HZO infection.

Summary We report what we believe is the first documented case of keloid formation on the penis following circumcision.

A 16-year-old Bangladeshi girl presented with a 9-day history of an extensive pruritic, erythematous, papulovesicular skin eruption to both forearms. Appearance was 5 days following application of a home-made henna preparation. Examination revealed ulceration and scabbing along the whole henna pattern and early keloid formation. A diagnosis of type IV delayed hypersensitivity reaction superimposed by infection was initially made. As in this case, home-made henna preparations commonly combine commercial henna with black hair dye, paraphenylenediamine (PPD). PPD, widely known as 'black henna', darkens the pigment and precipitates the drying process. PPD is a potent contact allergen associated with a high incidence of hypersensitivity reactions. Despite treatment the patient was left with extensive keloid scarring in the pattern of the henna tattoo.

Keloid formation on the palms of the hands and soles of the feet is rare. A keloid developed 2 months after release of simple syndactyly in a young black child. The process of keloid formation is not completely understood, and surgical correction is not effective.

A case of umbilical keloid formation following cord separation in an infant is described. Treatment involved excision of the mass and reconstruction of the umbilicus with histological confirmation of the excised lesion. To our knowledge, this is the first report of an umbilical keloid occurring at such an early age.

Introduction Integra dermal matrix (Integra Life Sciences Corp., Plainsboro, NJ), introduced by Burke and Yannas in 1981, has been well established as an efficacious treatment option in the management of burn injuries. Its use has expanded beyond burn surgery to include other situations where full-thickness skin coverage is necessary. The acceptable cosmetic results commonly obtained through the use of Integra have prompted research into additional areas where minimal scarring is a priority. Case Description A 47-year-old African American male with a large recurrent keloid of the upper chest and lower neck region underwent surgical excision of the keloid and placement of Integra without the need for subsequent skin grafting after multiple other treatment modalities had failed. At 1 year postoperatively there were no indications of keloid recurrence and the regenerated dermal tissue demonstrated smoothness, pliability, and other acceptable cosmetic features characteristic of the use of Integra. Discussion Integra is produced as a type I collagen and chondroitin-6-sulfate matrix, which plays a significant role in reducing the inflammatory response to the wound. This prevents fibroblast activity from accelerating beyond the control of the wound repair mechanisms and in turn prevents the formation of excessive scar tissue. Immunologic studies have shown that the specific combination of collagen and chondroitin-6-sulfate results in a dampened immune response, thereby lowering the inflammatory drive. In addition, histologic studies have shown that chondroitin-6-sulfate prevents platelet aggregation and degranulation by blocking the platelet binding sites on the collagen fibers. Without this important first step in the inflammatory response the wound healing process can proceed at a self-regulating pace without the resulting hypertrophic scarring or keloid formation.

Pressure therapy is an integral part of keloid treatment. There are certain areas of the body which are prone to keloid formation but are not amenable to pressure therapy. The ear lobe is one such area. A simple, self fabricated and inexpensive pressure clip has been used for applying postoperative pressure to the ear lobe. This is fabricated with cold-cure poly methyl methacrylate and orthodontic wire. This has been used in 41 ear lobe keloids in 26 patients along with postexcisional triamcinolone acetonide therapy, 5 ear lobe reconstructions and 2 cases of ear lobe clefts over a period of 8 years. Although these clips are not very aesthetic, still the acceptability is very high as the patients were well motivated. A total of 27 ear lobes in 18 patients of ear lobe keloids have undergone ear boring after 6-18 months of pressure therapy. The only complication noticed is in the form of pressure ulcer due to continuous pressure in two patients at the beginning of our experience with these clips. These healed well after temporarily stopping the use of the clip.

On one hand, we know that cultural and ethnic stereotyping can lead to caricatures and to some of the vilest behavior in which human beings can engage. Instead of leading us to deal with people, stereotyping can lead us to deal with imagined versions of people, in a form of bigotry that has no place among health care workers. On the other hand, we know that there are trends and variables that play a role in how people respond to interventions and that many of these variables are culturally and ethnically dependent. We also know that members of different ethnic and racial groups might need special consideration for problems that are unique to those groups, such as the keloid formation that occurs among African Americans. The …

Scarring is one of the major problems associated with wound healing and, in particular, there is a great deal of morbidity associated with hypertrophic scarring and keloid formation. Many approaches have been taken to suppression of scar formation1 but few have been widely successful. It was therefore of great interest when, in this short note to The Lancet, Shah and colleagues presented a novel approach to prevention of scarring in healing adult wounds.

viduals are more predisposed. Among the African American, Hispanic, and Asian populations, keloids occur in 6% to 16% of individuals. Hormonal factors are also thought to contribute to keloid formation. Keloids can appear during puberty and regress after menopause. Patients with cutaneous disorders that have an inflammatory or infectious component, such as cellulitis, pilonidal cysts, and foreignbody reactions, have a special predisposition for keloids.

A rare case of huge Post operative keloid is presented. Exogenous suture material or tension on post auricular wound are probable factors of its causation. Hence their importance is stressed during aural procedures, The pathogenesis of keloid formation along with the management of the above case has been discussed.

The use of isotretinoin for the treatment of acne has increased over the past 10 years because of its effectiveness and the limited and generally reversible adverse effects associated with it. Although not mentioned in comprehensive reviews of the adverse effects of isotretinoin therapy, hypertrophic scar and keloid formation, both spontaneous and associated with cutaneous injury, are potential risks. 1 Dermatologists and cosmetic surgeons have noted an increased incidence of keloid and hypertrophic scar formation with dermabrasion, excisions, and argon laser treatment. 2,3 These therapies all share local disruption in the structure of collagen in the skin. The pulsed dye laser (585 nm, 450 microseconds) has been proven safe and effective treatment for various small-diameter vascular processes, such as capillary vascular malformations, hemangiomas, telangiectases, pyogenic granulomas, and angiomas. Using the principles of selective photothermolysis, the pulsed dye laser can deliver high-intensity energy to a target vessel with little to