SUMMARY
Keloids are benign hyperproliferative growths of dermal fibroblasts characterized by excessive, and often times extensive, deposition of extracellular matrix components especially collagen and fibronectin. First described in the Edward Smith papyrus in Egypt around 1700 BC, the aetiopathogenesis of the disease has become one of the greatest enigmas in modern medicine. Studies have shown that the condition is significantly more common in the coloured races, especially those of African origin. This brief exposition focuses on an exciting and potentially revolutionary study of this condition by the University College Hopital, Ibadan, team of plastic surgeons led by Professor Oluwatosin and collaborators from the University of Connecticut, USA. The team hopes to uncover the genetic basis of African keloids that may lead to the development of more effective diagnostic, therapeutic and prognostic interventions.
Perhaps the most fundamental process of primary interest to surgeons is wound healing. Wound healing involves a well-orchestrated sequence of events. The history of wound care is both ancient and modern. The treatment of acute and chronic wounds can be traced as far back as ancient Egypt and Greece. Galen of Pergamun, a Greek surgeon who served Roman gladiators circa 120–201 AD1, made many contributions to the field of wound care. In more recent times (1860 onwards) notable names include Ignaz Phillipp Semmelweis, Joseph Lister, Paul Leopold Freidrich (who introduced wound excision), Theodor Billroth, Theodor Kocher and others. These heroes of surgery made major advances to wound care and wound healing.
With the advent of modern scientific techniques, the practice of surgery has become founded on well researched scientific principles. Advances in cell biology have showed that wound healing is a complex event involving cellular, host, psychological, and environmental factors. The process of wound healing can be divided into inflammatory, proliferative, and maturation phases2. These phases are associated with very complex cascades of signaling molecules and growth factors. Studies have continued to improve the outcomes of surgically inflicted wounds, however, in a small percentage of individuals the proliferative phase takes an abnormal course resulting in excessive formation of scar tissue. Such non-malignant, abnormal outcomes of cutaneous wound healing, are referred to as hypertrophic scars and keloids.
Keloids are defined as scars within the skin that grow beyond the confines of the original wound. This process may be delayed for months, rarely years after the initial injury before starting but once keloids are formed, they do not regress spontaneously. In contrast, hypertrophic scars are raised lesions that stay within the boundaries of the wound. They usually appear within weeks of the causative injury and tend to regress spontaneously over time3. The first description of abnormal scar formation in the form of keloids was recorded in the Smith papyrus regarding surgical techniques in Egypt around 1700 BC. The term keloids meaning ‘crab claw’ was coined by Jean Louis Albert in 1806 3. Since that time the condition has gained the reputation of being one of the greatest enigmas in modern medicine.