burdensome wounds
There are three main stages of wound healing. The first is an inflammatory phase that prevents or limits further damage. There is a proliferation phase during which new tissue is formed. Among the many things that happen in this stage, specialized cells called fibroblasts produce collagen that helps form structural support for the new tissue. This propagation phase is not prudent; It can run in the background during the entire treatment process. Finally, there is a maturation phase when the new tissue settles into its final form and attains maximum strength.
When keloids form, it means that something has gone wrong in the proliferation phase of healing. Specifically, the fibroblasts of keloids are thought to be more active, live longer, and produce more collagen and more signaling molecules that promote growth. Collagen production in keloids can be up to 20 times greater than in normal skin.
It is not clear what causes this uncontrolled tissue growth, but genetics and environmental factors are thought to play a role. Keloids are seen more often in people with darker skin. In the teenager’s case, her doctors noted that varicella infection is known to trigger certain pro-inflammatory cellular signals and speculated that they could potentially induce a hyperproliferative state. But, for now, it is just a hypothesis.
Unfortunately, keloids are difficult to treat. When the problem is defective wound healing, any treatment that creates new wounds risks failing or worsening the problem. For example, surgical removal has a recurrence rate between 45 percent and 100 percent. Cryotherapy can sometimes be used to kill scar tissue, but it can also leave unwanted changes in the skin. Laser and radiotherapy have been used, but with obvious risks and sometimes limited results. Successful treatment often requires a combination of methods. However, the main treatment is injections of corticosteroids, which help with itching and burning.
In the teenager’s case, doctors monitored her keloids for three months and found that they were relatively stable, with no rapid growth — although they could potentially continue to grow over time. Given priorities and financial limitations, she decided to forgo aggressive treatment and live with the growth, managing symptoms with antihistamines and the over-the-counter pain reliever acetaminophen.
While keloids remain a threat, there is effective prevention of chickenpox. The varicella vaccine was released in the US in 1995, and two doses provide 97 percent protection. Since its introduction, cases and complications of chickenpox have declined dramatically.
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