|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 1 | Page : 92-93
Labial keloid: Rare presentation of a common malady
Raghav Shrotriya1, Tushar Thorat1, Vinita Puri1, Shruti Kulkarni2
1 Department of Plastic Surgery, KEM Hospital, Mumbai, Maharashtra, India
2 Department of Obstetrics and Gynaecology, KEM Hospital, Mumbai, Maharashtra, India
|Date of Web Publication||11-Dec-2015|
Dr. Raghav Shrotriya
Department of Plastic Surgery, Gynaecology Wing, 2nd Floor, KEM Hospital, Parel, Mumbai - 400 012, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shrotriya R, Thorat T, Puri V, Kulkarni S. Labial keloid: Rare presentation of a common malady. Indian J Burns 2015;23:92-3
A keloid is an abnormal proliferation of scar tissue that forms at the site of cutaneous injury which does not regress and grows beyond the original margins of the scar. The age, race, endocrine activity, increased skin tension, localized immune responses, and growth factors (transforming growth factor-beta) have all been found to be involved in the pathogenesis of keloids. , Africans and Asians have been found to have increased susceptibility to keloid formation. The deltoid, presternal area, ear lobule, and posterior neck are the regions most commonly found to develop the lesions. On the other hand, keloids on the palm of hand and sole of feet are virtually unknown.  Keloids on genitalia are very rare. There have been 10 reported cases of penile keloids.  However, extensive literature search conducted over the internet revealed only one report of labial keloid.  Here, we present a case of a large labial keloid secondary to burns.
A 20-year-old unmarried girl presented with an itchy and tender mass over the right labia majora for 3 years which was a cause of difficulty while walking and also an embarrassment. She was operated for right femur neck cyst curettage and artificial bone substitute injection for fibrous dysplasia 3 years earlier. Following surgery, she developed a thick scar over the right labia majora due to suspected cautery burns accidentally sustained intraoperatively and gradually developed into a keloid measuring 11 cm × 3 cm × 2 cm [Figure 1].
The patient had no evidence of hypertrophic scarring over other surgical sites and had no similar family history. Clinical diagnosis of keloid was made and given the large size and site of the lesion, surgical excision was performed with primary closure using monocryl 4-0 subcuticular sutures, and few 4-0 polypropylene interrupted sutures [Figure 2]. The patient has had a smooth postoperative course. The histopathology [Figure 3] was suggestive of keloid. Intraoperatively, injection triamcinolone was injected along the suture line. Postoperatively, she was started on silicone gel sheet from 8 weeks onward and was followed up bimonthly for 6 months. The result has been satisfactory over the postoperative period of 6 months [Figure 4].
Keloids are benign, hyperproliferative scar tissue growths, characterized by excessive deposition of collagen and other extracellular matrix components. Keloid differs from a hypertrophic scar in that it extends beyond the original wound margins and does not resolve spontaneously. Often arising secondary to operative procedures, risk factors for keloid formation include skin trauma, prolonged wound healing, infection, wounds in certain anatomical regions, and foreign-body reactions, especially in genetically susceptible individuals.
Keloids can vary in size from millimetres to centimetres in diameter, and are most common in areas, such as the posterior shoulder, presternal area, earlobes, and posterior neck. Keloids have the potential to be complicated by pruritus, tenderness, burning, secondary infection, ulceration, and restriction of motion.
The female genital region is commonly subjected to trauma due to obstetric reasons. In some African tribes, in spite of having a high rate of female circumcision, the incidence of genital keloid has not been reported. 
Rarity of keloids in genitalia is no less than an enigma. Though decreased skin tension in genitalia may be cited as a probable cause, no single clinical etiology may be pointed out. Embarrassment of disclosing a lesion in genitalia may be a contributory factor for this rare presentation.
Several modes of treatment exist for keloids; the most common therapy is surgical excision coupled with intralesional steroid injection and radiation therapy.  Due to the proximity of germ cells, though, radiation has not been a desirable therapy for labial keloids. Local recurrence rates of keloids removed by surgical excision alone can be significant, but surgery combined with injection(s) of corticosteroids can reduce the local recurrence rates to below 50%. However, steroid treatment carries the risk of adverse effects, including subcutaneous atrophy, telangiectasia, pigment changes, and systemic side effects.  Complete surgical excision with primary closure was the treatment administered to our patient.
The treatment of genital keloids deserves special attention. Intralesional triamcinolone injection is preferred for smaller lesions. Despite the risk of recurrence, larger ones can be excised and closed primarily.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]