Keloids are scar tissue that grow thick to very thick and can often form at the site of a skin injury. They mainly appear on ear lobes, cheeks, shoulder areas or the chest, but can pretty much appear anywhere on the body. Keloids seem to affect brown and black people the most but can affect non-black and brown people as well. The following article gives relevant data on how common keloids are in black and brown people:
Predominance of Keloids In Black and Brown People
Here is a relevant article quote:
Although keloids have been documented in virtually all major ethnic groups, they are most commonly seen in individuals of African, Asian, and, to a lesser degree, Hispanic and Mediterranean descent. Dark-skinned individuals form keloids 15 times more frequently than do their lighter-skinned counterparts.2 In both black and Hispanic populations, the incidence of keloid formation is as high as 16%, with higher frequencies during puberty and pregnancy.14 A slight female predominance is also noted, but this could be related to the higher rate of earlobe piercing in females.15 Although keloids can occur at any age, they are most likely to occur between the ages of 11 and 30 years.
There has been some suggestion that darker people have lower vitamin D levels, which could potentially make them more susceptible to keloids.
The following gives multiple images of keloids to give an example of how small they can be as well as how bad they can get, and this link is limited to milder images of keloids:
https://www.istockphoto.com/search/2/image-film?phrase=keloid&istockcollection=
This link shows images of more severe keloids and is not for the faint of heart:
Keloids are a common problem which are often difficult to treat or even slow their growth. One treatment modality is the use of steroid injections directly into the keloid, which can help to shrink the keloid over a period of months and multiple steroid injections, but keloids frequently start to grow again once the injections are stopped. Surgical removal is effective initially, but almost 100% of surgical removals return. Cryosurgery (freezing), often using liquid nitrogen to freeze the keloid is more effective on small keloids. Sometimes a combination of surgical removal with cryotherapy a couple of weeks after the surgical removal is a more effective approach to help prevent the keloid from returning.
Here are two article links discussing these aspects of keloid treatment:
Here is a relevant article quote:
The best initial treatment is to inject long lasting cortisone (steroid) into the keloid once a month. After several injections with cortisone, the keloid usually becomes less noticeable and flattens in three to six month's time. Hypertrophic scars often respond completely, but keloids and are notoriously difficult to treat, with recurrences commonly seen. People who have a family history of keloids have a higher rate of recurrence after treatment.
Here is a relevant article quote:
Cryotherapy, in the form of standard whole body, localized, or intralesional cryosurgery, has been shown to be the most effective, safest, and easiest-to-perform method of keloid removal. Also known as cryosurgery, the procedure involves the application of extreme cold to the keloid, often via liquid nitrogen.
So even though cryotherapy seems to be additive to surgical removal, keloids can still return depending on many factors such as the location of the keloid, size, family history, and type as discussed here:
Here is a relevant quote from the link:
Recurrence rate after successful removal of keloids with cryotherapy depends on several factors, including type, size and location of keloid lesions, as well as presence of keloids elsewhere and the family history of the disorder.
Vitamin D Deficiency and Keloids
One thing that is often seen in people with keloids is low vitamin D levels. The following study shows that intralesional injections of high dose vitamin D level is an effective treatment for keloids and may be a useful substitute for steroid injections, as discussed here in conjunction with patient pictures to show before and after images:
https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocd.14070
Here is a relevant study quote:
There was statistically highly significant reduction in Vancouver Scar Scale (VSS) after treatment with intralesional vitamin D injection (p value≤0.001). There was also statistically highly significant improvement in ultrasonic keloid scar thickness after treatment (P value ≤0.001).
This treatment required weekly injections directly into the keloids of high-dose vitamin D to obtain these results. Unfortunately, to the best of my knowledge, after searching for facilities offering this treatment, it apparently is not yet available to the public. In the study, they used vitamin D3, the commonly available form over the counter, and not the active form of vitamin D, Calcitriol, which is only available by prescription.
Part of the problem aside from vitamin D deficiency or insufficiency seems to be that people with keloids also have reduced expression of the vitamin D receptor (VDR), as discussed here :
https://onlinelibrary.wiley.com/doi/10.1111/wrr.13109?af=R
A relevant study quote:
A limited number of studies have found lower serum vitamin D levels in patients with keloids, and reduced expression of the vitamin D receptor (VDR) in keloid lesions compared with uninjured skin. Vitamin D has documented anti-inflammatory, anti-proliferative and pro-differentiation activities, suggesting it may have a therapeutic role in suppression of keloid fibrosis. Here we review the evidence supporting a role for vitamin D and VDR in keloid pathology.
Supplementing with vitamin D is known to raise vitamin D levels, but supplementing vitamin D has also shown the ability to increase VDR expression, as discussed in the following human study here :
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371728/
Here is a relevant quote from the study:
The objective of this randomized controlled study is to examine the effect of vitamin D supplementation on body composition and the expression of the vitamin D receptor (VDR) mRNA. An intervention was performed through supplementation with cholecalciferol at the concentration of 2000 IU in 90 healthy adult monozygotic twins (male or female pairs) for 2 months. The findings showed that serum vitamin D concentration increased by 65% and VDR gene expression sixty times (p = 0.001). Changes in body composition parameters were observed regarding body fat and lean mass. Our results indicate that an increase in serum vitamin D concentration may have potential therapeutic implications.
Interestingly, the above study showed that just 2000 IU of vitamin D per day increased the VDR by 60 times. This is useful information for people in general, but especially so for people who have health issues where VDR expression is very limited, such as people with keloids.
Recent studies are starting to show that vitamin D and VDR are important when it comes to keloids and even more so than previously thought. So it seems to make sense to be sure you are vitamin D replete at a bare minimum.
Since these vitamin D injections are not currently available, it got me thinking about possibly applying high doses of vitamin D to the surface of the keloids while supplementing oral vitamin D as a means to increase VDR expression at the same time. After some thought, I thought that insufficient vitamin D would be absorbed into the keloid.
DMSO and Keloids
This made me think of DMSO, which people often use as a transdermal penetration enhancer to carry various molecules through the skin and dermal layers. This kind of peaked my interest and so I started looking more at DMSO. That led me to this article:
https://academic.oup.com/asj/article/25/2/201/229513
Here is a relevant quote from this article:
Biopsies of keloids have shown histologic improvement after DMSO treatment.14 Thus, DMSO may be effective for this difficult problem.
The following rabbit study about the use of DMSO to fight scar tissue in the ear also suggests DMSO to be beneficial at breaking down scar tissue:
DMSO and Scar Tissue In Rabbits
A relevant study quote:
On the basis of the results, it can be concluded that intralesional administration of DMSO decreases hypertrophic scar formation easily and safely.
So this makes me wonder if taking oral vitamin D to increase vitamin D level as well as significantly increase VDR expression and then applying 70% DMSO to a keloid and then applying vitamin D from a high dose soft gel daily to the keloid would have a similar effect as the study results without the weekly injections?
Obviously, I am not recommending such an idea because it is untested, but perhaps it is time for science to step up and test such a simple remedy for such a dreaded health issue as keloids! How much could such a study cost as these are two inexpensive items, and neither of these, vitamin D or DMSO, are new drugs that would require a decade of testing if they were new drugs.
It seems like such an application early on in the life of a keloid could be quite beneficial at stopping it in its tracks before it could become any larger or increase in number. It is much less invasive than surgical removal.
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