Unwieldy wounds
Wound healing generally involves three primary phases. First is the inflammatory phase, which works to prevent or limit further injury. Then comes the proliferative phase, where new tissue begins to form. A key player in this phase is fibroblasts, which create collagen that provides structural support for the new tissue. This phase isn’t strictly defined; in fact, it can continue in the background throughout the healing process. Lastly, there’s the maturation phase, where the new tissue finalizes its shape and reaches its maximum strength.
The development of keloids suggests something has gone awry in the proliferative phase. Keloids are characterized by fibroblasts that seem to be more active, with a longer lifespan, and they produce significantly more collagen and growth-promoting signaling molecules. In fact, collagen synthesis in keloids can be up to 20 times greater than in normal skin.
The exact triggers for this excessive tissue growth remain elusive, though genetic and environmental factors are believed to contribute. Keloids are particularly common in individuals with darker skin tones. In the case of a teenager mentioned, her doctors indicated that varicella infections could potentially initiate certain pro-inflammatory signals, possibly leading to a hyperproliferative condition. However, this idea is still just a theory.
Unfortunately, treating keloids is quite challenging. Because the issue stems from improper wound healing, any treatment aimed at creating new wounds risks exacerbating the situation. For instance, surgical removal has recurrence rates ranging from 45 percent to 100 percent. Cryotherapy may sometimes eliminate scar tissue but can also lead to unwanted skin changes. Laser and radiotherapy are other options but come with clear risks and often variable outcomes. Generally, a combination of treatment methods tends to be the most effective. The primary treatment remains corticosteroid injections, which help alleviate itching and discomfort.
In the case of the teenager, doctors kept an eye on her keloids for three months. They observed that the keloids were fairly stable, showing no rapid growth, although they might still increase in size over time. Considering her preferences and budget constraints, she opted out of more aggressive treatment and chose to manage her symptoms with antihistamines and over-the-counter pain relief using acetaminophen.
While keloids can be quite troublesome, chickenpox has a notable prevention method. The varicella vaccine, introduced in the US in 1995, provides 97 percent protection with two doses. Since its introduction, the number of chickenpox cases—and subsequent complications—has significantly decreased.
