Envision walking down the street on a terribly hot summer day, looking over, and seeing a girl in a long sleeve shirt and jeans. You think to yourself, she is completely insane and looks ridiculous wearing the wrong season’s clothes, especially on a day like this. A person can only wonder why someone would ever do that to themselves. Ever since spring of 2013, I am able to express the feeling to need to cover up every inch of your body so that no one is able to see what is underneath.
I spent that entire summer in jeans because I was afraid to let the world see what had happened to my body. After all of the doctor’s visits that I had endured for months, the road rash I had gotten from flipping a golf cart had finally been turning into regular skin and I was finally feeling normal again. I thought that the weird looks I had been receiving from the sight of my legs, would be going away. However, during the healing process I had been experiencing extreme itchiness in the scars. The itching sometimes came with pain that would not go away unless I put lotion on my burns.
At times the sensation coming from the itching would be unbearable, but I let myself believe that it was the normal itching that comes with the skin healing. In addition to the extreme itching, when the new skin had begun to grow back it started out normal, but eventually it was much more elevated than my healthy skin. In all honesty, I never wanted to go back to a hospital or doctor’s office after the summer that I had with my burns which is why I did not tell anyone about the pain and itching that I had been experiencing.
One day I was on a boat with my dad’s cousin, Sherrie, who is a Physicians Assistant with a specialty in dermatology. Sherrie took one quick look at my legs and diagnosed me with having the disease Keloids. She told me that I was going to need treatment immediately, otherwise the keloids would continue to grow larger and eventually would not longer be treatable. That being the case, if I chose not to get treatment I would have the hideous raised scars for the rest of my life. After hearing this my heart sank.
I spent much of my summer in and out of the doctor’s office, attempting to fix the scars that have taken over my legs. This trip to Sherrie’s cottage was supposed to be a fun escape from everything, but now I had found out that I had to go to see her every six weeks to get treatment for my legs during the school year. Having a cosmetically disfiguring disease is a challenge because of the insecurities it can come with, but with proper education of treatment one can move forward and have relief when they know there are options to fix the keloids. Keloids is a cosmetically disfiguring disease.
Keloids is medically defined as, “An increased type I/III collagen ratio, decreased fibrillin-1 and decorin expression, increased dermal cellularity and increased expression of fibronectin, versican, elastin and tenascin in the reticular dermis and hyaluronan and osteopontin in the epidermis” (Salas, Ignacio Valenzuela, and Andrea Fernandez Miralbell 372). To put it another way, Dr. Porcia Love, the board-certified surgeon in dermatology, states “Keloids are the overgrowth of dense fibrous tissue that develops after healing of a skin injury” (Love, Porcia B. and Roopal V. Kundu 404). The body still believes that there is an injury at the site of the wound and continues to produce tissue until it is treated, otherwise the keloid will keep growing. Keloids are formed where any type of wound on the skin has occurred causing the skin to increase in size from being a flat scar to being four millimeters in height.
They also grow beyond the boundaries of the wound. Consequently, making the keloid look like an exaggerated scar (Shih, Barbara, and Ardeshir Bayat). Keloids can form right away after the injury or they can take up o a year to form. When the keloid has formed it will have a rough, firm, feel to it, comparable to the feel of a rubber band. Furthermore, the skin condition is commonly found in the genetics of the family or it can be caused by a mutation of the IL-6 gene. IL-6 gene is defined by Dr. Liji Thomas as “an endogenous chemical which is active in inflammation. ” This mutation, if the person has it, would cause the gene to not know when the wound is healed and continue to send signals telling the body to make more tissue for the wound.
In addition, “Individuals with deeply pigmented skin appear to be at higher risk, with an estimated prevalence of 4% to 16% among individuals of African, Asian, and Hispanic ancestry” (Schneider, M. , E. Meites, and SP Daane 227). If the keloid is formed and the person does not have darker pigmented skin, the gene for keloids is an autosomal dominant trait passed on through family members. After doing some research with my family history I found out that it ran in my genes from my father’s side of the family. Also, the keloids, are most common at age 16 to 30 years old.
When I developed my keloids I was 15. I was falling a little outside of the age range but close enough to it where it still is common for people my age to form them. In addition to the biological reasons for the keloids, there are physical reasons for the excessive scarring to form. If there is skin or wound tension, it is more likely that the keloid is going to form. If the wound is located in a place on the body that has an underlying bony and cartilage skeleton areas the tension will be increased causing the keloid formation to occur quicker and be larger.
My areas of keloids are all located in places with underlying bones close to the skin, mainly on my knees. One of my wounds was deep enough that you could actually see my knee cap, which means my body had an even tougher job to form enough skin to cover my bone up again. In the event of a keloid formation, a person can live their life without getting treatment for the keloids. However, there are symptoms that can be painful and annoying to deal with, that can cause a person to want the treatment even more than just for the cosmetic reason.
Symptoms include: a burning sensation, tenderness, painfulness, stiffness, and pruritic (Lee, Sarah Y. , et al. 397). The symptoms that occur with my keloids consisted of the tenderness, stiffness, and were extremely pruritic, which is also known as itching. Even though I could have gone without the treatment, the symptoms of the keloids and the cosmetic effect bothered me enough to go through with treatment. Although this disease can be cosmetically upsetting to the person that has developed it, there are various treatments available to help the keloid be flush with the skin.
For the larger keloids it is recommended that they have excision and after the excision is done, they should to continue with injections of triamcinolone. Triamcinolone is a steroid that is injected into the skin intralesionally, and it is meant to break apart the buildup of extra tissue and kill it. In doing this, it will soften the keloid and flatten it to make it feel like normal skin again. It is injected after the excision of the keloid to prevent it from forming again, as well as killing any leftover keloid. Although the injections can be used as a preventative, they also can be used as the only treatment for the keloid.
The amount injected ranges from 5 mg/cc – 40 mg/cc, every 4-6 weeks repeating till the keloid is flush with the skin. This form of treatment has an 86% success rate (Gauglitz, Gerd G. 103). In addition to the injections, some doctors will advise their patients to use silicone wraps in between appointments. These wraps are focused on flattening the keloid and are meant to be worn every day for 23 hours a day (Gauglitz, Gerd G. 103). This can be uncomfortable and inconvenient for many people, so this form of treatment is not often chosen. Another form of treatment is irradiation, also eant to kill the extra tissue in the area affected.
The results of irradiation have been inconclusive, many of the cases that have done this treatment have reported no change in the appearance of the keloid. Instead of irradiation alone, some people have done both excision and irradiation and there has been a success rate of 83% combining those two together (Gold, Michael H. , et al. 826). The last form of treatment is laser treatment. This is treatment is done by a pulsed dye laser that shoots vou at 585 nm every time, it is done straight into the site of the keloid anywhere from 10 times per keloid to hundreds of times.
This form helps the pigmentation of the skin to go back to normal as well as killing the extra tissue build up in the scar (Mamalis, A. D. , et al. 690). This is the form of treatment that| have been using, I have laser treatment combined with injections of triamcinolone into my keloids every six weeks. This has been very effective, and four of my six keloids are completely flat again, but my larger keloids are still getting treatment. While it is necessary for me to get treatment, going through with it has been one of the hardest things to continue.
Having the treatment will get rid of the excessive scars that are up and down my legs, but the odd feeling of the steroids being shot into my scars and the pain of the laser treatment is so unbearable that I struggle going back to get it every time. Every six weeks | have to go back and have lasers shot at my legs. I lay there on the bed with protective glasses on my face counting the times that Sherrie has shot my scars, hoping that each one will be the last one. There have been points in time where I have thought to myself that I wanted to be done with the treatment, but then I look down at my legs and see the keloids taking over.
If I stop the treatment there is a chance that they will never be normal, along with the fact that they could possibly grow bigger. In spite of all the treatment options that are provided by dermatologists, this is one of the hardest diseases to find a treatment that will cure for keloids forever. There currently is no way to prevent keloids completely, but there are ways a person with this disease can prevent themselves from developing keloids. To prevent a keloid formation, a person should not get anything that will change your appearance, such as surgery, tattoos, or piercings.
If a person has to undergo surgery the best option for prevention would be to immediately get injections to the site of the procedure and have pressure wraps around the wound to try and stop the keloid from forming. This aspect of prevention for me has been a struggle because I want to break the so called “rules” of not getting a tattoo or a piercing. I am an 18-year-old girl that can not go out on the weekend with her friends and get another ear piercing if I want to because of the side effects it could possibly have.
Since there is just a possibility and not a guarantee that I will be getting keloids for sure, if I go through with one of these things, it makes it even more tempting to just test it out and hope that a keloid will not form.. Although getting a piercing or a tattoo is a minor thing that many people do not want anyways, being told that you will never be able to get one has an effect on you. Living in fear of judgment in the summertime, when I did not want to show my legs to anyone, brought a huge insecurity on me. When I was informed of the treatment possibilities, it was one of those times where the news was good and bad at the same time.
I was scared that the treatment was not going to work, and I would be getting my hopes up for nothing, but then there was the factor that if the treatment worked, I would be normal again. This was the point in time where I had to accept the fact that there is a possibility my legs will never look the same again. Once I accepted this, my insecurities faded away. Although, having keloids is one of the hardest things that I have to go through, I have moved on. When people ask me about my scars, I find the strength to explain to them what it is and not let it upset me.
