Botox may reduce the incidence of keloids, improving the appearance of scars

Can a modern-day drug cure an age-old healing disorder that causes more harm than the actual injury?

Ongoing studies at Baylor College of Medicine in Houston are examining the use of botox and other medicines in reducing the incidence of keloids and improving the appearance of scars. Identifying the cause and cure for keloids, fibrous tissue outgrowths surrounding skin lesions and occurring most often in African-Americans, is almost as mystifying today as when they were first documented in ancient Egyptian times.

"If there is a lot of tension, activity or movement around the wound, there is a tendency for keloids to form," said Dr. Anthony Brissett, assistant professor in the Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences and the study's principal investigator as well as director of keloid clinics at BCM and the Harris County Hospital’s District's Ben Taub General Hospital.

Researchers in the study, funded by the Mayo Foundation, are analyzing whether botox injections that "paralyze" the affected area may relieve enough tension to enhance healing and improve scars.

The slightest break in the skin - a mild scratch, an ear piercing or even a mosquito bite - can trigger an overabundance of scar tissue in people with keloids, which tend to occur above the neck and most often in dark-skinned individuals. The fibrous outgrowths continue to swell if untreated, causing pain, itching, and grotesque disfiguration.

Until a cure is found, current treatments may include the use of steroids, surgical excisions, silicone gel creams, radiation therapy, and customized pressure clips that hydrate the wound area. Brissett estimates that 60 to 70 percent of his patients respond favorably to a combination of these therapies although regular follow-up visits are vital – and lifelong, in many cases.

"The problem with keloids is that they are extremely difficult to treat," said Brissett. "I tell my patients that this is a chronic problem and that we will see each other for treatments for the rest of our lives."

Keloids are hardly rare: Brissett estimates that 5 to 15 percent of black populations suffer from them. For reasons that are still unclear, statistics show African-Americans are 15 times more likely to develop the disorder than people with lighter skin. Brissett, also the director of the Baylor Facial Plastic Surgery Center, hopes that greater attention will be devoted to keloid research, especially given the rising trend of cosmetic surgery among African-Americans and Hispanics in recent years.

"Keloids are an under-studied area," said Brissett, "but now with an interest in tissue engineering and wound healing, with more of a cosmetic-type focus and a scientific approach to tissue engineering, we are noticing that people are beginning to identify various models of wound-healing."

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