Definition And Description

Keloid is characterized by the development upon the skin of one or more flattened smooth-surfaced tumors of varying size and shape. In some cases the natural color of the skin is maintained, but in others it is heightened, and in still others may be a little paler than normal, even quite white, and presenting a cicatricial aspect. Sometimes arms or processes project from the main body of the tumor and extend as thin bands into the surrounding skin.

Varieties

Authors usually designate two kinds of Keloid, the true and the false, assigning the former name to those oases that arise spontaneously, and the latter to such as develop subsequent to a wound or other irritation of the skin. This division might be wise from an etio-logical point of view, if we were always able to distinguish between the two by their aspect or course. This, however, we cannot do. We know as a fact that the so-called false or spurious Keloid may arise from the most trivial wound, as of a leech-bite or pin-scratch, and it would be exceedingly difficult, in many cases of apparently true Keloid, to exclude the occurrence of an anterior traumatism of this character. In fact, it is within the bounds of probability that all Keloids are the result of traumatism or local irritation induced by pre-existing skin lesions, as sycosis, acne, syphilitic lesions, etc.

Course

Keloid, once appearing, usually pursues a slow, indolent, and non-inflammatory course. It gradually increases in size, and additional patches may appear, so that three or four, or even a dozen or more distinct lesions are met with on the same patient. After a time some of them may come to a standstill while others develop into tumors of considerable size, causing much inconvenience to the patient.

Diagnosis

As a rule the diagnosis of Keloid is easy. Its most frequent seat, when apparently spontaneous, is the region of the sternum. Its appearance is very characteristic, looking like a large elevated scar, and it can hardly be mistaken for any other cutaneous affection except a hy-pertrophied scar itself. Form this latter it is to be distinguished by its history, course, and progress. The scar, having attained its maximum development, in a short time becomes stationary, while Keloid continues to increase for a much longer period of time, and fresh Keloids appear on the slightest provocation.

Prognosis

The prognosis of Keloid is, as a rule, unfavorable. Instances of spontaneous involution and disappearance have been noticed, but these are few in number. A few cases also of Keloid, arising after other cutaneous affections, have been dissipated by treatment, but the great majority persist indefinitely and for lite.

Etiology

The etiology of Keloid is obscure; in fact, nothing definite is known on the subject.

Treatment

It must be confessed that the treatment of Keloid is anything but promising. At first thought excision would seem to offer an appropriate measure of relief. Unfortunately, however, experience has shown that Keloid almost invariably returns after the use of the knife.

Under these circumstances an operation of this sort would only be warranted in cases where the tumor had attained such a magnitude that by its mere size it interfered with the functions of the part on which it was seated, or produced other serious inconvenience to the patient. The operation should be regarded as merely a means of temporary relief.

In two eases of Keloid that had followed sycosis, and one case that followed small-pox, I have seen an almost complete disappearance of the tumors under treatment. In the first two cases absorption occurred under the use of the Ungt. Potassii Iodidi, continued, as the state of the parts would permit, for several months. The third case was under the care of my friend, Dr. N. G. McMaster. He made incisions into the tumor about one-fourth of an inch in depth and one-twelfth of an inch apart. After the hemorrhage had ceased, the parts were dried, and pure acetic acid was brushed on several times, allowing an interval for drying between each application. Besides the use of a vaseline dressing and fomentation of the part in very hot water for five minutes at a time, night and morning, nothing more was done for a week, when it was noticed that the part operated on had diminished in all its measurements, especially in prominence. Three more operations, a week apart, so reduced the growth that its elevation above the skin was hardly appreciable.

Wilson (77, 332) says: "For my own part, I prefer, after regulating the general functions of the system, the maintenance of a steady course of Donovan's solution, in doses of ten drops, three times a day; or of the protioduret of mercury in combination with guaiacum and the oxy-sul-phuret of antimony. The false Keloid I have succeeded in removing by means of three-grain doses of the iodide of potassium three times a day, and a Plummer's pill at bedtime.

"Locally, the best applications are, collodion, to produce mechanical pressure; liquor plumbi diacetatis, as a sedative, to be pencilled on the tumor; the preparations of iodine, either the tincture or the solution of iodide of ammonium, as recommended for scrofulo-derma, or an ointment of iodide of lead, in the proportion of two parts of lead to one of lard. The latter relieves immediately the prickling and uneasy sensation that often accompanies Kelis. Great comfort is frequently given by the galbanum and opium plaster, spread on wash-leather; or if there be no irritation, soap plaster or diachylon on wash-leather."

Tilbury Fox (61, 350) says: "I do not know of any better plan than the continuous application of contractile collodion to the tumors, to which the hypodermic solution of morphia may be likewise applied for the relief of pain."

Squire (81, 84) recommends chloride of ammonium, cod-liver oil, or the alkaline iodides internally, and ointments of iodine, or of the various iodides externally. He adds that stimulating mercurial preparations are of service.