At a recent Alatro webinar in July, Mr. Ioannis Goutos, a consultant plastic surgeon with a special interest in scar management, shared his experience and clinical expertise in a presentation covering various aspects of keloid scarring, from pathophysiology to innovative approaches in treatment.

Mr. Goutos has previously collaborated extensively with IORBC President Richard Schaffer in providing radiotherapy treatment for keloid scarring. In this post we look at some of the key highlights of his presentation.

Understanding Keloid Scars

Keloid scars are characterised by excessive collagen production that extends beyond the boundaries of the original wound. They often manifest as prominent, mushroom-like growths, causing patients distress due to their unsightly appearance, itch, and pain. Mr. Goutos emphasised the importance of recognising the histological structure of keloid scars, which consists of a vascular base, a glass-like hyalinised collagen scaffolding, and hyperproliferative margins that contribute to their growth.

Challenges in Keloid Scar Management

Keloid scars may pose several challenges for clinicians as published studies report variable treatment outcomes, making comparisons difficult. The pathogenesis also remains a mystery and clinical histological diagnosis can be ambiguous.  Furthermore, keloid scars are not as extensively studied as other dermatological conditions, which can limit the availability of evidence based care protocols.

Pathogenesis and Predisposing Factors

Mr. Goutos shed light on the genetic and systemic factors influencing keloid scarring. While no specific keloidal gene has been identified, genetic predisposition is linked to single nucleotide polymorphisms. Systemic factors, such as high blood pressure and hormonal imbalances can exacerbate keloid development. Additionally, tension on the skin, especially in high-risk areas like the chest and back, appears to play a significant role in keloid formation.

Diagnosis Challenges

Distinguishing between keloid and hypertrophic scars can be challenging. The appearance and histological features may overlap, making accurate diagnosis essential for effective treatment.

Treatment Modalities

Mr. Goutos highlighted two main approaches in keloid scar management:

1. Minimally Invasive Techniques: These include injectables like steroids as standalone treatments or in combination with laser resurfacing for symptom improvement and reducing scar size.

2. Surgery and Radiotherapy: For patients seeking comprehensive scar modification, surgery followed by radiotherapy is the gold standard. Surgical techniques involve extralesional excision, where the keloid is removed along with healthy skin to minimise recurrence.

Advancements and Future Prospects

Mr. Goutos provided insights into potential future modalities for keloid management. Platelet-rich plasma (PRP), known for its regenerative properties, and botulinum toxin, which affects fibroblastic regulation, hold promise. Ongoing research aims to determine their efficacy in postoperative keloid scar management.

Key Takeaways and Recommendations

Multidisciplinary Approach: Mr. Goutos emphasised the importance of a multidisciplinary approach involving plastic surgeons, dermatologists, and radiation specialists to achieve optimal outcomes in keloid scar management.

Surgical Techniques: Extralesional excision, followed by radiotherapy, is a preferred surgical technique for keloid scars, as it minimises the risk of recurrence.

Stay Informed: With ongoing research and emerging treatments like PRP and botulinum toxin, staying informed about the latest advancements in keloid scar management is crucial for clinicians and patients alike.

Mr. Ioannis Goutos’s comprehensive insights into keloid scar management offer hope and guidance for individuals seeking effective solutions and, as the field continues to evolve, patients and practitioners can look forward to improved outcomes and enhanced quality of life.