By Leon Lidigu
Health Reporter
Nation Media Group
What you need to know:
- Keloid scars are usually shiny, hairless, hard and rubbers, red or purple at first before becoming brown or pale. They are hairless and can last for years and sometimes do not form until months after the initial injury.
- Though they are very common in Kenya, there is little to no research done and the government does not have any data that shows exactly how many people are battling them.
One Saturday afternoon in June 2020, Peris Ayuma walked into a local backyard chemist in Ruiru, Kiambu County with a Sh50 banknote in hand.
She wanted two more piercings, one on each of her earlobes, but little did she know that her quest for beauty would later see her part with Sh50,000 as she grappled with treating what grew from a raised scar on both lobes to keloids.
When a wound heals, it leaves a scar but a keloid or keloid scar is one that becomes thick, lumpy, raised and larger than the original wound.
“I did not know they would keep getting larger since they were then still tiny, so I wasn’t concerned about them,” 27-year-old tells Healthy Nation.
She had read that mechanical pressure can help minimise or slow their growth and so she started using bigger stoppers to cover them, but it did not work. They only grew bigger.
“I became restless and worried and decided to settle on new hairstyles that would cover my ears apart from seating at the back row whenever I boarded a matatu so that no one would stare at me.”
Peris decided to have them removed last December.
She came across a steroid known as Triamcinolone acetonide intralesional injection, which she wanted to self administer, but the drug was not available in all pharmaceutical shops she visited.
Peris learnt that silicone gel sheets would do the job but they would take forever and they only work for small scars. She checked out pressure earrings but the hustle of shipping from abroad seemed too much.
She looked at cryotherapy (a procedure in which an extremely cold liquid or an instrument called a cryoprobe is used to freeze and destroy abnormal tissue) but it seemed too expensive and only one hospital was offering the service. The most suitable option was the laser excision followed by steroid injections, which seemed more affordable and practical.
“In April this year, I went for the laser excision at Keridam Clinic and the procedure cost Sh50,000. It covers surgery and the steroid injections monthly for six months. The injections are administered one month after the surgery and they charge Sh1,000 for consultation,” Peris says.
But she is not alone. Sue Wanzala* is also battling keloids.
She pierced her ears when she was five years old with a needle “because every other girl in my class wanted to wear earrings”.
“I am a sucker for earrings because for 21 years, I wore all sorts of bling ; from Lamu silver earrings to Dubois — all sorts of African and trendy, the studs, cluster, drop, dangle, hoop, huggie, thread earrings, golden among others and never had any irritation,” the 34-year-old narrates.
But it was childbirth that brought her keloids. She had a cesarean delivery in 2015 and as the wound was healing, she noticed something growing on it “after which my ears started getting some extension and I immediately stopped wearing earrings.”
Sue discloses that the wound had healed but the scar was ugly because a keloid about two inches long grew on it.
Witchcraft
“I started telling my sisters that my husband would think it was witchcraft. I sought medical intervention, booked an appointment with a dermatologist who explained the situation and gave me treatment options,” she explains.
The mother of three says when she consulted her insurance, it refused to cover.
She gave up, consoling herself that at least the ‘ cesarean section keloid’ can only be seen by one person and as for the ears, she wore studs to hide them but little did she know they would get bigger and so she got off earrings completely.
Four years later while expecting her second born child, Sue was up for another cesarean again.
“My gynaecologist agreed to inject the scar with some medicine that she said would heal it well without forming a keloid again. It never worked and I still have an uglier CS scar, I can’t stand it.”
Keloid scars are usually shiny, hairless, hard and rubbers, red or purple at first before becoming brown or pale. They are hairless and can last for years and sometimes do not form until months after the initial injury.
Though they are very common in Kenya, there is little to no research done and the government does not have any data that shows exactly how many people are battling them. The number could be much more than you are imagining right now.
Christine Ndunge, a mother of two who lives in Mukango village, Ebambwa on the outskirts of Kakamega town, knows the frustration and helplessness keloids come with too well as they have tormented her since 2007.
“I used to see women putting on earrings and would marvel at their beauty. I decided to visit a salon in town and undergo the procedure so that I could also start donning earrings and enhance my beautiful looks,” the 37-year-old narrates.
But after undergoing the procedure, she realised that there were swellings developing on her earlobes two weeks later.
She started noticing that there were big and itchy nodules forming on her earlobes, which continued growing bigger and bigger. “I did not know what to do.”
In the last 15 years, they have recurred six times, forcing her to be operated on each time.
After the delivery of her first born they showed up again and were emitting a foul smell. She did not know how her husband would cope with her condition and so she got another operation.
But just as she was beginning to settle down, hoping the keloids would not recur, the vicious cycle began all over again.
“At the Moi Teaching and Referral Hospital (MTRH) in Eldoret, I paid Sh25,000 for the operations and injections. My ears were wrapped in bandages and this made it very painful. After the doctor removed the bandages, I realised I had lost my earlobes. I felt so sad.”
Victor Mwene, 33, who hails from Busia County, reveals that keloids do not only go after women.
His keloid started just like a small pimple after a shave back in 2010 then grew into a big lump of a scar and in October 2012, he went for the first operation to remove it.
“I was advised to first get an injection after which it was cut off but after the operation, it grew back bigger and became very itchy,” he opens up.
He decided to go back to the same hospital where he was first operated on.
“The doctor advised me to go for more kenacort injections.”
According to experts who warn that this drug may make one more susceptible to viral infections, a kenacort injection is a steroid used for the treatment of a wide variety of medical conditions such as osteoarthritis and rheumatic disorders and provides relief by preventing the release of substances that cause inflammation by suppressing the immune system.
“For months, I had four injections, one injection per week after which the doctor performed a second operation to cut it out in 2014. I went back for four injections just as before but unfortunately the keloid came back much bigger than the first and second time, and the itching became more severe.”
In 2019 it was bigger and had lots of puss. He met another doctor who cut them off again but the keloid came back, now bigger and with infections.
“To be honest I am defeated, helpless and so frustrated because this thing kills your self-esteem as a man,” Victor, in tears, narrates.
The American Academy of Dermatology (AAD) observes that sometimes, a surgical scar turns into a keloid and some women who have had a CS or hysterectomy get keloids after the surgery.
Some people get keloids when serious acne clears or chickenpox fades while it’s also possible to get a keloid after an insect bite or shot for a vaccine, or wearing tightly braided hair and even some men who shave their face develop keloids in their beard area.
“It’s also possible for keloids to form on uninjured skin and these are called ‘spontaneous keloids’ , which usually appear on the chest and develop in people who have a family history of developing keloids,” AAD says.
“When keloids develop spontaneously, it’s more likely that several keloids will appear. It’s still not clear why some people’s skin scars this way.”
While noting that children and the elderly rarely get keloids, researchers say that between 10 and 30 years of age is the peak time to develop keloids and most people begin seeing them in their 20s although they can develop earlier or later.
According to Dr Pranav Pancholi, a Kenyan skin dermatologist, keloids are genetic, which means one is more likely to have keloids if one or both of their parents had them.
“Keloids are a very common problem in the African skin and the reason for this is the genetic make-up, they are very common around the ears, on the chest, arms and the back.
Statistics estimate that 10 per cent of people experience keloid scarring and people with darkly pigmented skin are more prone to keloids.
The expert explains that keloids start with a micro-trauma in most cases and a lot of people have a genetic predisposition to keloids. They normally come about after skin trauma from an ear piercing, tattooing or a pimple on the chest or back which grows uncontrollably. “The first sign of a keloid is a raised scar. Whenever you have any kind of growth, it is imperative to get it checked early by a dermatologist,” Dr Pancholi says.
He explains that instead of the cells stopping to multiply after an injury or scar, they continue multiplying to form a keloid. They are therefore caused by an excess of structural proteins (collagen) in the skin during healing.
“There is no way of one knowing if they can get a keloid or not, they may have a genetic predisposition but there is no way of telling because you may get a keloid on your ear but when you have an injury on your hand it does not show up there,” the dermatologist says.
Piercings
He adds that the most important thing is that if you have a familiar tendency of keloids then be very careful about getting body piercings or tattoos and if you have had a keloid, never go for any other piercings because the risk is too high.
About one third of people who get keloids have a first-degree blood relative (mother, father, sister, brother, or child) who had them.
Dr Pancholi, however, highlights a number of treatment options such as intralesional injections, laser treatment, radiotherapy and surgical excision.
“However, surgical excision and radiotherapy are not my favourites because when you cut a keloid, you are causing injury again to the skin and so there is a high chance that the keloid can recur or even come back bigger and so excision should be avoided. And if you do it, you should do radiotherapy afterwards.”
The expert discloses that he discovered his own way of treating keloids, where he does cortisone injections (injections that can help relieve pain and inflammation in a specific area of your body) combined with a laser and through the laser channels in the skin, he introduces medication to calm down the keloid and shrink it.
The procedure takes 15 minutes and depending on the size of the keloid, a patient needs one to five sessions, which are performed between two to four week intervals.
He notes that if a keloid is too large then you are wasting your time trying to inject it, you are better off taking the patient for surgery.
Dr Pancholi believes what he charges for the treatments is fair. “If you want to come for a laser treatment, you are looking at a cost of Sh 20,000 per session depending on the number of sessions you will require. This is all after careful analysis and examination that we will decide on the correct course of treatment and the costs would vary depending on the number of lesions and the type of treatment required,” he expounds.
Considering the fact that there is no single proven treatment for keloids, scientists are still working round the clock and have come up with stem cell therapy.
Fat grafting, which has recently been explored as an adjuvant therapy for keloid and hypertrophic scars, is believed to improve scar cosmesis and enhance tissue regeneration in keloid patients.
[email protected]
Additional reporting by Benson Amadala. [email protected]
