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Medical Edge Newspaper Column from Mayo Clinic
SEVERAL OPTIONS AVAILABLE TO REDUCE KELOID SCARS
DEAR MAYO CLINIC: As you may know, we African-Americans are prone
to keloid scarring, and I have a horrible keloid from a C-section that
was done when I gave birth to my daughter in 2000. I have been receiving
steroid injections, with some (but not enough) success. Is there any other
help out there for me? — San Diego
ANSWER: Keloid formations are raised overgrowths of scar tissue
that, as you note, are common among African-Americans. They typically
occur at sites where surgery, vaccination, body piercings or acne has
injured the skin. Once formed, they may continue to grow for weeks, months
or even years, depending on the individual. Their appearance can be unsightly.
Keloids, which affect men and women alike, don’t look like other scars.
They tend to be smooth, shiny and raised, and they may range in color
from pink to brown. While keloids are largely a cosmetic concern, they
can be itchy and tender.
There are a few options for treating keloids. Nonsurgical treatments include:
— Injecting corticosteroids (typically given at intervals of four to six
weeks), which you’ve already tried.
— Covering the keloid with moist, silicone-gel sheets.
— Applying liquid nitrogen every 20 to 30 days. (Please note, however,
that while this treatment can reduce keloids, it may also have the side
effect of lightening skin color.)
A skilled and experienced surgeon can also make a fresh attempt at removing
the keloid or can use a laser treatment on the keloid. Both carry some
hope for improvement, as certain postsurgical techniques can be used to
minimize recurrent keloid formation. These include covering the healing
wound with hypoallergenic paper tape or silicone-gel sheets for several
weeks after surgery.
— Paul Petty, M.D., Plastic Surgery, Mayo Clinic, Rochester, Minn.
Additional Resources:
Treatment of Keloid
Scars
Appointment
Information
DEAR MAYO CLINIC: My mother has always had tiny pinprick-sized
red spots on her lips. She was recently admitted to the emergency room
for shortness of breath while visiting relatives. The doctors asked a
lot of questions about her spots, our family history and my mother’s health
— specifically nosebleeds, which she does get occasionally. They said
she could have a more complicated condition. They wanted to take an MRI,
but my mother wanted to wait until she got home. She feels better now
and is refusing the MRI. What do you think? — Fort Dodge, Iowa
ANSWER: Your mother may have a genetic disorder of the blood vessels
called Hereditary Hemorrhagic Telangiectasia — also called Osler-Weber-Rendu
syndrome. HHT can affect the brain, lung, liver, respiratory system and
gastrointestinal tract, so it is important that she see a physician experienced
in HHT to diagnose it and determine the appropriate treatment.
An estimated 500,000 people in the world have HHT. In this condition,
a mutation in one of three genes causes various blood vessels to lose
the vital connections between arteries and veins. There are many symptoms
and complications, the most dangerous being strokes and blood vessel abnormalities
— called arteriovenous malformations — in the lung or brain.
AVMs in the lung can cause shortness of breath and low oxygen levels.
Symptoms vary significantly from person to person. Some people have no
symptoms; others have mildly irritating symptoms; and some people can
have symptoms that are disabling and life threatening.
The red spots on the lips (which can also appear on the fingertips) are
an especially conspicuous feature of HHT. Though not problematic, they
indicate possible blood-vessel abnormalities elsewhere — such as in the
lungs, liver and brain — that require extra testing. Nosebleeds are the
most common symptom of HHT. Frequency of nosebleeds can range from occasional
to persistent, lasting weeks and contributing to anemia. Gastrointestinal
bleeding is another symptom that patients age 50 and over sometimes experience.
The ER physicians were astute in suggesting that your mother may have
a more complicated condition and encouraging her to seek additional care.
If genetic testing shows that your mother does in fact have HHT, there
is a 50 percent chance that you also have it, so you may also want to
consider being tested.
— Karen Swanson, D.O., Pulmonary and Critical Care Medicine, Mayo Clinic,
Rochester, Minn.
Additional Resources:
Pulmonary and Critical
Care
Appointment
Information
More
Information on Hereditary Hemorrhagic Telangiectasia
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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