All of the following statements about keloids are true EXCEPT
|A||A keloid does not regress spontaneously.|
|B||A keloid extends beyond the boundaries of the original wound.|
|C||Keloids or hypertrophic scars are best managed by excision and careful reapproximation of the wound.|
|D||Keloid tissue contains an abnormally large amount of collagen.|
a. Hypertrophic scars (HTS) and keloids represent an overabundance of fibroplasia in the dermal healing process.
b. HTS rise above the skin level but stay within the confines of the original wound and often regress over time.
c. Keloids rise above the skin level as well, but extend beyond the border of the original wound and rarely regress spontaneously .
d. Both HTS and keloids occur after trauma to the skin, and may be tender, pruritic, and cause a burning sensation.
e. Keloids are fifteen times more common in darker-pigmented ethnicities, with individuals of African, Spanish, and Asian ethnicities being especially susceptible. Men and women are equally affected.
f. Genetically, the predilection to keloid formation appears to be autosomal dominant with incomplete penetration and variable expression.
g. Excision alone of keloids is subject to a high recurrence rate, ranging from 45 to 100%. There are fewer recurrences 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.
h. Surgery is recommended for debulking large lesions or as second-line therapy when other modalities have failed.
i. Silicone application is relatively painless and should be maintained for 24 hours a day for about 3 months to prevent rebound hypertrophy.
j. External compression is used to treat HTS, especially after burns. Therapy must begin early, and a pressure between 24 and 30 mm Hg must be achieved in order to exceed capillary pressure, yet preserve peripheral blood circulation.
k. Garments should be worn for 23 to 24 hours a day for up to 1 or more years to avoid rebound hypertrophy. Scars older than 6 to 12 months respond poorly.