A 34-year-old man presented with a progressively enlarging lesion on his left calf. He reported that about 3 months prior he had developed a small ulceration at this location following a fall. With local wound care, the ulceration healed with a scar. The scar, however, continued to grow beyond the borders of the previous ulceration and became raised with violaceous discoloration. The patient denied any history of excessive scarring or keloid formation after skin surgeries or trauma. There were no personal or family histories of granulomatous diseases. Results of a physical examination showed an erythematous-to-dusky plaque measuring approximately 4X3 cm (Figure 1) on the left calf with well-defined irregular borders and discrete papules on the internal aspect of the knee. No tender nodules on the shins were noticed, and no lymphadenopathy was present. Results from a review of systems and a routine chest x-ray were unremarkable. Results of a punch biopsy revealed changes consistent with sarcoid naked granulomas (Figure 2). The patient was started on topical potent corticosteroid tapes and experienced marked improvement.
For severe cases, the keloid can surgically excised and given x-ray treatments to the site immediately afterwards, usually the on the same day. This works in about 85% of the most severe cases. Electron beam radiation can be used, which will not go deep enough to affect internal organs. Orthovoltage radiation is more penetrating and slightly more effective. There have not been any reports of this causing any form of cancer in many years of use, but it is very expensive. Silicone pads and creams are sold over the counter for use on keloids. These do benefit hypertrophic scars but will not cure a true keloid. However, they can reduce pain, swelling and itching from a keloid. They usually take 3 months or more to work.
How it works: According to Dr. Edwards, stress produces chemicals in the body that increase inflammation. “With relaxation techniques, you have stress reduction and therefore decreased inflammation and less pain,” she says. Meditation also relaxes muscles that tense up with pain. Dr. Edwards suggests meditating for 20 minutes once or twice a day. For moments of acute pain, she also recommends “meditation minutes.” For example, take four to five deep breaths, counting to 10 with each inhalation and exhalation. “Just doing that four to five times a day can decrease depression and improve outlook,” she says.