Determination of the prevalence, clinical characteristics and histopathological features of keloids in patients managed at the Kenyatta National Hospital

Abstract

Objectives: Assess prevalence and clinical presentation, describe histopathology and determine association of clinical presentation with histopathological findings of keloids.

Design: Cross-sectional study conducted over two months.

Setting: Plastic surgery outpatient clinic at the Kenyatta National Hospital.

Subjects: Patients undergoing keloid treatment.

Interventions: Obtained clinical history based on a calibrated protocol and pain and pruritus scores based on a visual analog scale. Using numbers ranging from zero being no symptoms, to ten being unbearable symptoms of either pain or pruritus and registered as per the questionnaire. Excisional biopsy was performed, and specimen submitted to Kenyatta National Hospital histopathology department.

Main outcome measures: Demographics: age, sex, religion, economic status; Presentation: pain, pruritus, location: parasternal, earlobe; and Histology: predominant cellularity: neutrophils, mast cells, macrophages, fibroblast density.

Results: Most patients presented with a solitary keloid, trauma was a major trigger factor, with oval as the commonest shape, regular margins. Histologically mast cells and lymphocytes were the majority of cells seen and a high keloid collagen. On correlation of clinical presentation with the histopathological findings of the keloids; we found a strong association between pain, pruritus and mast cells abundancy.

Conclusion: Current approaches to keloid management are based on an algorithm including surgical excision, intralesional steroids, cryotherapy, laser removal, radiotherapy, occlusive dressings, and immunomodulators. From our findings, there could be further role of mast cell stabilizers or leukotriene receptor antagonist such as montelukast. We recommend that further studies be carried out on keloid immunocytochemistry and cytogenetics in correlation with clinical findings to support keloid management.