Hypertrophic Scar And Keloid

hypertrophic scar and keloid

Q. 1

Keloid formation is least likely seen over :

 A

Ear

 B

Deltoid

 C

Eyelid

 D

Presternal region

Q. 1

Keloid formation is least likely seen over :

 A

Ear

 B

Deltoid

 C

Eyelid

 D

Presternal region

Ans. C

Explanation:

Keloids can result from surgery, burns, skin inflammation, acne, chickenpox, zoster, folliculitis, lacerations, abrasions, tattoos, vaccinations, injections, insect bites, ear piercing, or may arise spontaneously.

Keloids tend to occur 3 months to years after the initial insult, and even minor injuries can result in large lesions.

They vary in size from a few millimeters to large, pedunculated lesions with a soft to rubbery or hard consistency.

Although they project above surrounding skin, they rarely extend into underlying subcutaneous tissues.

Certain body sites have a higher incidence of keloid formation, including the skin of the earlobe as well as the deltoid, presternal, and upper back regions.

They rarely occur on eyelids, genitalia, palms, soles, or across joints.

Keloids rarely involute spontaneously, whereas surgical intervention can lead to recurrence, often with a worse result.
  
Ref : Barbul A., Efron D.T. (2010). Chapter 9. Wound Healing. In T.R. Billiar, D.L. Dunn (Eds), Schwartz’s Principles of Surgery, 9e.

Q. 2

Which of the following is given in the form of an intralesional injection to treat keloid?

 A

Heparin

 B

Triamcinolone

 C

Danazole

 D

Hydrocortisone

Q. 2

Which of the following is given in the form of an intralesional injection to treat keloid?

 A

Heparin

 B

Triamcinolone

 C

Danazole

 D

Hydrocortisone

Ans. B

Explanation:

The long acting steroid Triamcinalone is used for treating keloid.

Other treatment modalities include laser, silicone sheets, cryotherapy, interferon, fluorouracil, radiation.


Q. 3

Keloid scars is made up of-

 A

Dense collagen

 B

Loose fibrous tissue

 C

Granulamatous tissue

 D

Loose areolar tissue

Q. 3

Keloid scars is made up of-

 A

Dense collagen

 B

Loose fibrous tissue

 C

Granulamatous tissue

 D

Loose areolar tissue

Ans. A

Explanation:

Ans. is ‘a’ i.e., Dense Collagen


Q. 4

Most common site of hypertrophic keloid is –

 A

Face

 B

Leg

 C

Presternal area

 D

Arm

Q. 4

Most common site of hypertrophic keloid is –

 A

Face

 B

Leg

 C

Presternal area

 D

Arm

Ans. C

Explanation:

Ans. is ‘c’ i.e., Presternal area 

  • Keloids —> It is a scar which shows extreme overgrowth so that scar tissues grows beyond the limits of original wounds and shows no tendency to resolve.
  • Keloids grow on particular sites, these are ‑

a)         Central chests (probably most common, not sure)

b)         Back

c)         Shoulder

d)        Earlobes

Other points about Keloids & hvpertrophic scars

  • Hypertrophic scars (FITS) and keloids represent an overabundance of fibroplasia in the dermal healing process. They are both characterized by excessive collagen deposition versus collagen degradation.
  • HTS rise above the skin level but stay within the confines of the original wound and often regress over time.
  • Keloids are defined as scars that grow beyond the border of the original wound and rarely regress spontaneously.
  • Both HTS and keloids occur after trauma to the skin, and may be tender, pruritic, and cause a burning sensation.
  • Keloids are more prevalent among dark pigmented ethnicitics (i.e. Africans, Asians & Hispanics)
  • HTS usually develop within 4 weeks after trauma Keloids tend to occur 3 months to years after the trauma.

Q. 5

All are true about keloid except:

 A

Grows beyond wound margin

 B

Excess collagen deposition

 C

Precancerous leading to cancer

 D

All

Q. 5

All are true about keloid except:

 A

Grows beyond wound margin

 B

Excess collagen deposition

 C

Precancerous leading to cancer

 D

All

Ans. C

Explanation:

Ans. is ‘c’ i.e. Precancerous leading to cancer

  • There is no evidence of malignancy in keloids.
  • Keloids have equal incidence in both males & females [Ref. Schwartz 9/e p225 (8/e, p240); Roenigk & Roenigk’s

Dermatologic Surgery: Principles & Practice by Randall K. Roenigk, Henry H. Roenigk 2nd/e, p 604 (http://books.google.com)] [The above referred book on google.com writes that – “The incidence of keloids is usually reported to be equal among males and females, although some studies do report a higher incidence among females. This is most likely considered attributable to the greater frequency of ear piercing and the greater cosmetic cancers in the female population.”

Note that Bailey & Love 24/e, p 93 says the keloids to be more common in females.

Pathology & Genetics of skin tumors by IARC, Philip E. Leboit p 254 (on books.google.com) write – “Keloids occur with equal frequency in men & women”.


Q. 6

First line t/t for keloid is-

 A

Intralesional injection of steroid

 B

Local steroid

 C

Radiotherapy

 D

Wide excision

Q. 6

First line t/t for keloid is-

 A

Intralesional injection of steroid

 B

Local steroid

 C

Radiotherapy

 D

Wide excision

Ans. A

Explanation:

Ans. is a’ i.e. Intralesional injection of steroid 

  • Intralesional injection of steroid (Triamcinolone acetate) is now recommended as the first line of t/t for keloids

[Ref Schwartz 9/e p226 (8/e p241)]

  • Intralesional injection of Triamcinolone is also the t/t of choice for intractable hypertrophic scars. Success is enhanced when it is combined with surgical excision [Ref CSDTI 3/e p1105 (11/e, p1243)]
  • Other modalities of tit used for keloids are:

a) Surgery

– surgical excision alone leads to a high recurrance rate.

– there are fewer recurrances when surgical excision is combined with other modalities such as intralesional corticosteroid injection, topical application of silicone sheets or the use of radiation or pressure.

– surgery is recommended for debulking large lesions.

b) Radiation therapy

–  it may produce unpredictable results and has obvious potential side effects including neoplastic degeneration; and has high recurrance rate when used alone.

c)         Silicone sheet application

d)         Pressure application

e)       Topical retinoids


Q. 7

Drug used for intralesional injection of keloid is ‑

 A

Prednisolone

 B

Triamcinolone

 C

Androgen

 D

Hydrocortisone

Q. 7

Drug used for intralesional injection of keloid is ‑

 A

Prednisolone

 B

Triamcinolone

 C

Androgen

 D

Hydrocortisone

Ans. B

Explanation:

Ans. is ‘b’ i.e., Triamcinolone 

  • Triamcinolone acetonide is the drug used for intralesional injection of steroid.

Also know

  • Treatment of hypertropic scars/Ref: CSDT13/e pI105 (11/e p1243)]
  • Since nearly all hypertrophic scars undergo some degree of spontaneous regression, they are not t/t in early phases. If the scar is still hypertrophic after 6 months surgical excision and primary closure of the wound is indicated.

Other modalities used for t/t of HTS.

  • Pressure application – particularly useful for burn scars.
  • Silicone sheet application
  • Intralesional injection of triamcinolone is the t/t of choice for intractable HTS.

Q. 8

Keloid scar is made up of ‑

 A

Dense collagen

 B

Loose fibrous tissue

 C

Granulamatous tissue

 D

Loose areolar tissue

Q. 8

Keloid scar is made up of ‑

 A

Dense collagen

 B

Loose fibrous tissue

 C

Granulamatous tissue

 D

Loose areolar tissue

Ans. A

Explanation:

Ans. is ‘a’ i.e., Dense collagen 


Q. 9

What is true about keloids –

 A

It appears immediately after surgery

 B

It appears a few days after surgery

 C

It is limited in its distribution

 D

It is common in old people

Q. 9

What is true about keloids –

 A

It appears immediately after surgery

 B

It appears a few days after surgery

 C

It is limited in its distribution

 D

It is common in old people

Ans. B

Explanation:

Ans. is ‘b’ i.e., It appears a few days after surgery 


Q. 10

The following statement about keloid is true ‑

 A

They do not extend into normal skin

 B

Local recurrence is common after excision

 C

They often undergo malignant change

 D

They are more common in whites than in blacks

Q. 10

The following statement about keloid is true ‑

 A

They do not extend into normal skin

 B

Local recurrence is common after excision

 C

They often undergo malignant change

 D

They are more common in whites than in blacks

Ans. B

Explanation:

Ans. is ‘b’ i.e., Local recurrence is common after excision 



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