Keloid
Introduction
Introduction to keloid Keloid is a process of healing skin lesions. Collagen anabolism can lose normal restraint control, and it is continuously hyperactive. As a result of excessive proliferation of collagen fibers, it is also called connective tissue hyperplasia. It is called crab foot in Chinese medicine. Swelling or giant scars, it manifests as a benign lumps that have normal skin, different shapes, and hard red color. basic knowledge The proportion of illness: 0.15% Susceptible people: no specific population Mode of infection: non-infectious Complications: scar cancer
Cause
Cause of keloid
Skin damage (50%)
Mainly caused by various types of skin damage, even minor injuries, such as mosquito bites, vaccination, ear piercing, eyebrow tattoo, needle stick injury, scratching, hemorrhoids, etc., skin infections, trauma, burns or burns can cause Keloids. Hypertrophic scars are hyperproliferative scars that develop after various traumas or surgeries. This patient has the quality of scarring.
Genetic factors (25%)
Mainly affected by the level of scar and the level of estrogen in the body, this constitution is mostly family-inherited, most of which are cross-inherited but not contagious.
Abnormal growth of scar tissue is closely related to many factors. Scar is an important component of the body's self-defense system. It is both the healing process of wounds and the inevitable result of healing. Healing goes through 3 stages.
1. Exudation stage: exudation of plasma, lymph, leukocytes, phagocytic cells, etc. in the wound. The autolysis process caused by phagocytosis, removal, absorption, etc., and enzymes assisted by damaged cells, removes necrotic tissue and contaminated bacteria, foreign bodies, etc., and the network formed by cellulose will form the surface layer and deep layer of the wound. Initially bonded together. Clinically, the local area of the wound is slightly red and swollen.
2, collagen stage: with inflammatory exudation, the proliferation of fibroblasts and capillary endothelial cells gradually appear, fibroblasts are gradually aggregated to form collagen with the participation of glycine, hydroxyproline, hydroxylysine and other substances. Fiber and collagen fibers have a high degree of toughness, which increases the tensile strength of the wound. At this time, the skin has a reddish scar, slightly bulging, hard toughness, and itching.
3. Mature stage: Collagen fiber is continuously synthesized, and under the action of collagenase, it is continuously decomposed. After about one month, anabolism and catabolism are gradually balanced, and fibroblasts are transformed into fibroblasts and collagen fibers. Gradually become a neatly arranged bundle, capillaries are occluded, the number is reduced, and the skin scar begins to undergo degenerative changes. The clinical manifestation of scar hyperemia subsides, the color is slightly darker than normal skin color, or slightly pale pink, and the scar is flatter than before. The texture is becoming more flexible and the matrix is becoming looser.
Prevention
Keloid prevention
1. According to the dermatology general care routine.
2. Patients in the initial and second phases should be exposed to isolation.
3. Cardiovascular syphilis, neurosyphilis, pregnant women or pediatric patients should refer to various specialist care.
4, underwear is best to wear pure cotton products;
Complication
Keloid complications Complications scar cancer
In addition to affecting the appearance, keloids have no other complications and adverse effects. Keloid is a kind of connective tissue hyperplasia. It is called "crab foot swelling or giant mark" in Chinese medicine. It is manifested as normal skin. A benign mass with a different shape and a reddish color.
1. Scar surface impregnation: Occurred in the elastic band fixed or immature scars, due to friction, can shorten the wearing time to avoid, also suggested that it is best to start treatment 6 to 8 weeks after wound healing, should not be too late.
2. Sweat: Mostly due to local uncleanness, it may have itchy symptoms, disappear after cleaning the local and silicone gel film, and does not affect the continued treatment.
Symptom
Keloid symptoms Common symptoms Zhangkou difficulty Repeated infection Scars Itchy wounds Scars Giant scars Sickness After injury, it is easy to produce scars, scars, skin abrasions, skin moles, valgus
() marks can be divided into two major categories: original hair and secondary hair. The original hair () marks are mostly in front of the chest or behind the shoulders, starting with small red spots with itching, gradually from small to Large, from soft to hard, red or dark red, with cord-like, butterfly-like, round irregular shape.
Examine
Keloid examination
1. Chest X-ray examination, if necessary, for bone photography.
2. Blood and urine routine examination.
3. Early syphilis has skin and mucous membrane damage, can be used for dark-field microscopy of syphilis.
4. Should be tested for syphilis serum. The primary screening test included a rapid plasma reaxin loop card test (RPR) or a serum unheated responsive slide test (USR). Confirmed tests included the fluorescent spirochete antibody serum adsorption test (FTA-ABS) and the Treponema pallidum hemagglutination test (TPHA).
5. Late syphilis should be used for cerebrospinal fluid examination, including cell count, total protein measurement, and sexually transmitted disease research laboratory slide test (VDRL test).
6. Perform a biopsy of the skin if necessary.
Diagnosis
Keloid diagnosis and identification
diagnosis
Diagnostic criteria
(1) The course of disease is more than 9 months without signs of spontaneous regression.
(2) Skin damage exceeds the original damage range and invades the surrounding normal skin.
(3) Those who have undergone surgical resection or freezing, laser, hormone blocking or radiotherapy, etc., have relapsed.
Common in young and middle-aged, both sexes can be involved, the front chest, upper back and upper arm are good hair parts, sometimes seen in the buttocks, female patients can also be seen in the earrings, the skin lesions are clearly defined, high out of the skin Scarred plaques, nodules and even lumps, irregular shape, sometimes the edges of the crabs expand outward, the lesions are often red in the proliferative phase, the surface may have telangiectasia, the color can be dimmed later, in the stationary phase Skin lesions may even be close to normal skin tone, sometimes the marginal zone of the larger lesion is in a proliferative phase and is red, but the center of the lesion is in a stationary phase and the color is close to the normal skin tone. The patient often feels itchy, due to local friction, compression or climate change. Other factors can also cause itching or tingling. Some patients have local hypersensitivity to skin lesions, and even mild irritation causes significant discomfort (Figure 2).
1. Diagnostic steps
(1) Asking medical history: It is the first step to identify scar hyperplasia and keloid, guide the choice of treatment plan, and correctly judge the outcome of prognosis. The medical history includes:
1 Cause: The cause of scar formation must be recorded, among which the main causes of classification diagnosis and treatment are: flame burn, chemical burn, hot crush, car accident, knife and other trauma, surgery, cosmetic surgery, etc. Iatrogenic injury, vaccination, foreign body burial, skin infectious diseases, insect bites, hemorrhoids, and unexplained damage.
The scars of wounds caused by different causes have different clinical features and pathological features, and the outcomes and prognosis are different. The diagnosis and classification are different. For example, deep second degree burns and chemical burns are prone to hyperplasia. Scars, hemorrhoids can form depression scars, or hypertrophic scars caused by repeated infections, insect bites or unexplained scars are likely to be keloids.
2 degree: the degree of damage formed by various causes should be as clear as possible. When possible, the condition record of the injury should be requested. Burns, car accidents and knife wounds are common causes, but different degrees of damage can form different types of scars.
3 time: When is the injury, how long has the scar since the formation of the scar, the concept of time helps to analyze when the scar is in time, and is easy to choose the timing of surgery.
4 treatment or not: whether there is treatment at the beginning of the injury, whether there is treatment after scar formation, what treatment is given, the treatment before treatment can help to analyze and judge the injury and scar condition, and more help to absorb the experience of the former, choose treatment Program.
5 Wound healing process: Whether the wound after wounding is healed automatically or healed by dressing treatment, whether the healing process is smooth, how long it took for the wound to heal from wounding to healing, and whether the wound has re-ruptured after healing, repeated ulceration How many times, interval, how to heal each time, how long it lasts.
The smooth healing process of the wound helps the classification of scar diagnosis, prognosis, and the length of the initial wound healing. It also helps to analyze the depth of wound damage. For example, the wound may heal within 1 week, and the injury may be shallow second degree burn, skin abrasion. The wound is healed within 2 to 3 weeks, and the injury may be deep second degree burn; the wound is healed for more than 3 weeks, usually a third degree burn, and the whole skin is damaged.
6 with or without contagious infection: whether the wound has a concurrent infection directly affects the depth of the wound, the nature of the scar, the type, the scar after infection is mostly hypertrophic scar.
7 There are no symptoms of itching pain: most of the scars have no symptoms of itching, proliferative scars of hypertrophic scars and painful scars have itching symptoms, and itching does not necessarily exist at the same time.
8 functional effects: whether the scar directly affects the movement of the joints after the formation of scars, whether the organ where the scar is involved, such as the presence or absence of scars on the back of the hand, resulting in limited flexion of the metacarpophalangeal joint, can not make a fist, mouth or lip scars caused by small mouth deformity, Difficult to open mouth, or lip valgus, runny, etc.
9 Progress and changes: What changes in the color, thickness, hardness, size, itching sensation and function of scars from scar formation to treatment.
10 other parts of the body: to understand the presence or absence of scars and related conditions, to avoid the omission of diagnosis, to ensure the integrity and practicality of the treatment plan.
11 Family history: There are no scars or similar scars in the relatives of the patients.
12 treatment requirements: what is the patient's treatment requirements, the expected value of the surgical effect, whether the patient's mentality of seeking treatment is objective, accessibility, motivation for seeking medical treatment, purpose, etc. should be clearly understood and documented.
(2) Specialist examination: The physical examination includes full physical examination and local scar examination. The whole body examination is not described in this chapter. The scar specialist examination should grasp the following points:
1 site: The location of the scar must be based on the anatomical site, accurately recorded, such as "the left upper eyelid margin in the middle of the scar."
2 number: single or multiple scars, sometimes a scar occurs in several adjacent organs at the same time, the range of involvement is different, the depth of involvement is also different, these should be thoroughly and accurately checked and recorded.
3 Shape: The scar shape may be strip, round, oval, triangular, or irregular, and may be flat, concave or bulging.
4 Area: The size of the scar area should be recorded in plan view data, in cm2, such as flaky scar record: length × width; circular scar record: long diameter.
The extent of the lesion is divided by the area calculation record. It should be noted whether the scar area exceeds the original damage range. The excess should consider keloid, which helps the differential diagnosis of scar.
5 Thickness: The thickness of the scar can be measured, detected and recorded in cm, and can also be described in terms of thin, thick, slightly thick, flat, and thin.
6 hardness: the texture of the scar can be the same as the surrounding skin or slightly harder than normal skin; tough, hard, hard, pay attention to the difference in toughness and hardness.
7 mobility: whether the relationship between scar and the surrounding, the base tissue is tight, whether the base can move, the degree of mobility, these are more meaningful for the diagnosis of scar and the timing of surgery.
8 color: scar surface can be bright red, purple red, pink, slightly red, dark purple, brown, porcelain white, close to the skin color and other colors, the surface can also have telangiectasia.
9 contracture situation: scar tissue has contracture characteristics, but not all can cause contracture deformity, contracture deformity can cause the scar itself to shrink, the plate is hard, the mobility is poor, can also cause the adjacent organs to pull deformation.
10 secondary malformations: In addition to its ugly shape, scar tissue, due to its persistence of contracture, can also cause secondary deformities of surrounding organs, such as eyelid valgus, lip valgus, chest adhesions, claw-shaped hands and so on.
11 dysfunction: Some scars can cause functional disturbances in their organs or joints, such as scars and contracture scars.
12 concurrent malformations: deformities in the presence of wounds and scars, such as ear defects in the ear, nose, eyebrows, eyelids and other organs.
13 Erosion around the scar: whether there is normal skin erosion around the edge of the scar, extended red or dark red extension, and some shapes like crab feet, this phenomenon is an important sign for identifying keloids.
14 ulcer smell: unstable scars can appear ulcers, but if the smell of ulcers is stench, it should be highly suspected of the presence of scar malignant, or other malignant tumors of the skin.
(3) Laboratory and auxiliary examination: Scar histopathology is a reliable basis for the diagnosis of scar classification and differential diagnosis of scar and malignant tumors. Its significance is much greater than other examinations. The serum and urine hydroxyproline content is the degree of scar hyperplasia. And reference indicators for dynamic observation.
(4) Image recording: Since some scars are irregular, accurate description is difficult, so the retention of image data is more important. Image data is captured by the camera at most, and cameras and computer cameras are used.
Image retention is mainly before and after surgery or before and after treatment, so attention should be paid to the size ratio and brightness, and the consistency of the background.
2. Diagnostic criteria
Any one or more of the following may be diagnosed.
(1) Skin damage exceeds the original damage range and invades the surrounding normal skin.
(2) The course of disease is more than 9 months without signs of spontaneous regression.
(3) Those who have undergone surgical resection and relapsed.
3. Judgment of the severity of scars.
Differential diagnosis
Attention should be paid to the difference between hypertrophic scars. The early two can not be distinguished, but there are significant differences in degree. Hypertrophic scars show excessive growth of connective tissue proliferation and hyaline degeneration, generally 3-4 weeks after injury. Occurred inside, at this time the scar ridges thickened, forming a clear plaque, reddish or red, with small capillary expansion, sustained or intermittent growth for several months to several years, forming an irregular appearance, sometimes like crab feet It usually stops growing after several months of growth, and the flushing disappears. There is still the possibility of natural degeneration. In addition, the fiber bundles can be fused and shrink and elastic fibers appear.
1. Hyperplastic scar (hyperplastic scar), also known as hypertrophic scar or hypertrophic scar, is not qualitatively different from keloid in histopathology, only the degree of difference, so the difference between the two lesions mainly depends on clinical Performance and other laboratory tests.
Early keloids and hypertrophic scars are difficult to distinguish between clinical features and pathological manifestations. The following principles should be observed: For suspicious patients, the medical history should be detailed, including the cause of the disease, the evolution process, and the local stimuli. The response to treatment is made to rule out the diagnosis or confirmation of keloids.
2. Sometimes it must be differentiated from cutaneous fibroma, scarring sarcoidosis, and histopathological examination can help to confirm the diagnosis.
