Recurrence of Primary & Secondary Keloids in a select African American and Afro-Caribbean population
Elysa Margiotta, MD1, Sean Ramras, MD2, Elizabeth Kasparov3, Aleksandr Shteynberg MD3,4
1Maimonides Medical Center, Brooklyn, NY, 2Waterbury Hospital, Waterbury, CT, 3SUNY Downstate Medical Center, Brooklyn NY, 4Kings County Medical Center, Brooklyn, NY
Background: Primary and secondary keloid formation occurs with increased incidence in African Americans and Afro-Caribbeans when compared to other ethnic populations. Although surgical and non-surgical management of keloids are mainstays of treatment, there are significant variations within studies comparing the efficacy of intraoperative steroid injection, postoperative radiotherapy or a combination of both modalities. The purpose of our study is to evaluate the efficacy of different treatment modalities used for treatment of keloids and to determine their recurrence in a select Afro-Caribbean population.
Methods: A retrospective review of the plastic surgery case list from January 2015-October 2019 was conducted, with identification and selection of 46 Afro-Caribbean and African-American patients with 56 keloids. Each patient was contacted between 3 months to 4 years post-operatively to determine whether or not they had experienced recurrence of their keloid(s). Eleven patients were lost to follow-up, resulting in 28 patients with [N = 35] keloids included in our study. The treatment protocol involved surgical excision for all keloids, with selective additional Kenalog 40 mg/mL injection intraoperatively [N = 15], immediate postoperative radiotherapy [N = 6], or intraoperative Kenalog 40 mg/mL injection with postoperative radiotherapy [N = 3]. Recurrence rates between the different treatment groups were calculated, and statistical analyses were performed using IBM SPSS Statistics, with a value of p < 0.05 deeming statistical significance.
Results: Based on patient participation, our study demonstrates that postoperative recurrence rates of primary and secondary keloids were 43% and 58% respectively. Result:s of recurrence rate varied by specific treatment modality; keloid excision only yielded a rate 54%, keloid excision with postoperative radiation yielded a rate of 83%, keloid excision with intraoperative Kenalog injection yielded a rate of 33%, and keloid excision with a combination of intraoperative Kenalog injection and postoperative radiation yielded a rate of 33%.
Conclusion: Patients of Afro-Caribbean and African-American ethnicity are more heavily affected by the formation of keloids compared to other population groups. Result:s of varying modalities for keloid management demonstrate that patients who received a combination of excision with intraoperative Kenalog injection, with or without postoperative radiation, had the lowest recurrence rates compared to other treatment protocols including excision alone and excision with postoperative radiation only.
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