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Keloids as a Serious Disease Such as Malignancy

2008; Lippincott Williams & Wilkins; Volume: 122; Issue: 3 Linguagem: Inglês

10.1097/prs.0b013e31818120a0

1529-4242

Rei Ogawa,

Skin Diseases and Diabetes

Sir: I would like to make a positive comment on a letter by Dr. Jeffrey A. Arons1 in the February issue of the Journal. He drew attention to the fact that an article about keloids was published in the “Cosmetic” section of the Journal. I agree completely with the opinion of Dr. Arons that articles regarding scar management, including keloid and hypertrophic scar treatment, would be better classified in the “Reconstructive” section or into a new section with a title such as “Burn Reconstruction and Scar Management” or “Wound Management.” Because abnormal scar formation should be considered excess wound healing, and because these treatments are closely related to wound management, it might also be a good idea to create a wound-healing section in the Journal that would describe treatments for fresh wounds, chronic ulcers, and abnormal scars. Keloids are a severe problem for Asian and African American patients, but less so for Caucasians, in whom severe keloids are extremely rare. Thus, it may come as a surprise to the Editors of the Journal that the main complaints of Asian and African American patients with keloids are feelings such as irritable pain and itching and a stretching sensation. Cosmetic issues, such as the ugly shape, pigmentation, and depigmentation, are not primary complaints in many severe keloid patients (Figs. 1 and 2).Fig. 1.: Photograph demonstrating a case of a severe chest acne keloids in an Asian patient.Fig. 2.: Photograph demonstrating a case of a severe shoulder acne keloids in an Asian patient.Even in Japan, many keloid patients have been refused treatment, including surgery and postoperative radiation therapy, because (1) there is a fear that if the primary keloid is treated by surgery, a secondary, larger keloid may appear later; and (2) postoperative irradiation includes the risk of malignant tumor generation, which seems to be too much of a risk to take for a disease that is neither cancerous nor mortal. As shown in Figures 1 and 2, many keloids undergo uncontrolled growth and can become quite large. For this reason, it is particularly important to treat keloids in young patients because of the danger of permanent disfigurement later. Unfortunately, this is quite often overlooked by physicians who think of keloids as just a cosmetic problem. Thus, surgeons should not hesitate to perform aggressive treatment on keloid patients, including surgery and postoperative radiation therapy, especially for young patients, who because of their enhanced sensitivity to their personal appearance are particularly likely to suffer from the long-lasting psychological damage associated with this problem.2,3 This is the reason why reports on keloid treatments should not be classified under the heading “Cosmetic” but under the heading “Reconstructive.” Although keloids are considered to be a pathologically benign fibroproliferative disease, keloids do not result in death. We have considered keloids to be a serious source of mental pain, equivalent to that experienced by patients with malignant diseases. Only patients with keloids may be able to understand this distinction in its fullest sense. Unless the attitudes of plastic surgeons toward keloids change, many keloid patients will continue to suffer unnecessary mental pain, which is unpardonable in the context of medical science today. Rei Ogawa, M.D., Ph.D. Nippon Medical School Tokyo, Japan