Keloid formation

Anticoagulants History of local radiotherapy History of Keloid formation Pregnancy/breast-feeding Heavy smokers... 

Etiology Factors Contributing to Scar Healing and Keloid Formations... 

Fig. 3. Summary of metabolic interactions involved during keloid formation. Abbreviations LA, linoleic acid AA, arachi-donic acid OA, oleic acid PGE2, prostaglandin E2 IgG, immunoglobulin G TGF-p, transforming growth factor- 3.

Louw, L. (2000) Keloids in Rural Black South Africans. Part 1 General Overview and Essential Fatty Acid H5fpotheses for Keloid Formation and Prevention, Brostaglandins Leukot. Essen. Fatty Acids 63, 237-245... 

In contrast, in persons with darker-colored skin, chemical peeling may be indicated for PIH, if care is taken to avoid irritation which can worsen PIH and predispose to other complications, including new areas of dyspigmentation, keloid formation, and hypertrophic scarring [342],... 

You will need to watch this patient closely as they may develop delayed wound healing and a potential for scarring with hypopigmentation or keloid formation. You can never go back, so it is better to err on the side of the light white. It is difficult to neutralize TCA to prevent this burn. Usually, by the time we see the deep white or yellow it is too late to neutralize. However, those with experience like Kim and Bill Cook can neutralize with a spray of bicarbonate solution within seconds of application. They can control the higher strengths. This takes practice. 

Before performing the peel, an extensive patient history should be obtained, with particular attention paid to a history of delayed wound healing and hypertrophic scar formation. Also, dark skin patients must be questioned about their general health status, medications, smoking, previous cosmetic procedures, such as surgical lifts or fluid silicone injections, keloid formation, side effects and results of previous cosmetic procedures, etc. If a patient has a history of recurrent herpetic outbreaks, prophylactic and postpeel antiviral treatment should be used. Systemic medications such as oral contraceptives... 

Past exposure to radiation in the neck, chest or other proposed site to be peeled is also relevant. Radiation diminishes the number of pilosebaceous units in treated areas and places these patients at an increased risk for development of postoperative scarring. Presence of adnexal structures can be assessed clinically by observation of vellus hairs or microscopically by performing a small punch biopsy as Brody describes. Similarly, a history of hypertrophic scar or keloid formation is also relevant especially if peeling will take place in high risk areas such as the chest, back shoulders and junction of the jaw and neck. 

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