Challenging Diagnosis of a Rare Case of Spontaneous Keloid Scar

Abstract

Keloid scars are benign dermal collagenous lesions that arise in the reticular layer of the dermis as a result of a period of prolonged wound healing due to injurious cutaneous insult. It is diagnosed clinically by a history of injury preceding its appearance and its pathognomonic encroachment beyond the boundary of the original wound. There are multiple factors that predispose an individual to keloid scar formation but no single hypothesis sufficiently explained its complex pathogenesis. The spontaneity of keloid scar to arise de novo without prior cutaneous injury is very rare. Although the non-specific appearance of spontaneous keloid scar can resemble various malignant or benign tumors, it is of paramount importance to accurately diagnose it due to the difficulty and complexity of keloid scar treatment or the atrocious outcome of its mismanagement. Here, we presented a rare case of spontaneous keloid scar over an unusual site of occurrence, and its disfiguring consequences as a result of misdiagnosis and treatment. We also highlighted the diagnostic challenge facing many clinicians when spontaneous keloid scar occurred in an individual without significant predisposing factors. Therefore, extra vigilance should be exercised in our practice and the spontaneity origin of keloid scar should be borne in one's mind.

A Case of Multiple Spontaneous Keloid Scars

“…These are Dubowitz syndrome, Rubenstein-Taybi syndrome, Noonan syndrome, Goeminne syndrome and conjunctivo-corneal dystrophy [ 3 , 4 , 5 , 6 , 7 ]. Apart from these occurrences, single spontaneous keloid scar on the face has also been reported in two otherwise healthy men, in a 13-year-old on the preauricular region of the face and in an 81-year-old over the postauricular region [ 8 , 9 ]. Because of the rarity of spontaneous keloid scar, it is important to bear in mind the differential diagnosis of lesions resembling keloid scar, such as sarcoidosis and various malignant and benign tumors [ 10 ].…”

A case of multiple spontaneous keloid scars: Letter to editor

“…7 Review of litertures have shown apart from these occurrences, single spontaneous keloid scar on the face has also been reported in two otherwise healthy men, in a 13-year-old on the preauricular region of the face and in an 81-year-old over the postauricular region. 8,9 Due to rarity of conditions resulting in spontaneous keloidal scar one needs to differentiate this entity from its closer mimics such as sarcoidosis and other benign and malignant tumours. 10 The findings of our patient, did not fit with any of the syndromes metioned above nor did it represent any syndrome in particular.…”

Correlation of Melanin Content with Collagen Density in Keloid Patients

“…The ratio of keloids between dark-and light-skinned people is between 5 and 18.7. Meanwhile, no case has been reported in albinos [3], [5], [6].…”

“…It is characterized by a wide, slightly soft, and shiny surface lump and disrupting the appearance. The exact mechanism for its occurrence has not been fully resolved, although several theories have explained its causes [1], [2], [3].…”