Archives of Dermatological Research

, Volume 307, Issue 2, pp 109–114 | Cite as

Clinical and epidemiological analysis of keloids in Chinese patients

  • Wen-sheng Lu
  • Xiao-dong Zheng
  • Xiu-hua Yao
  • Lan-fang Zhang
Original Paper


Keloids are common abnormally raised fibroproliferative lesions that can occur following even minor cutaneous trauma. There are limited data on Chinese patients with keloids, and the purpose of our study was to investigate the clinical and epidemiological features of keloids in Chinese patients. Assessment was performed by unified, designed questionnaires. A total of 715 patients were enrolled and statistical analysis and heritability were performed using EPI INFO 6.0, SPSS13.0 and Falconer’s method. Keloids occurred typically between the ages of 10 and 30 years, and the mean age of initial onset was 21.14 ± 13.45 years in females and 22.55 ± 11.36 years in males. The difference in the mean age of onset was not significant between males and females (p > 0.05). A greater severity of keloids was observed in the positive history family group than in the negative history family group, and this difference was statistically significant (χ 2 = 10.889, p < 0.05). The formation of keloids in multiple anatomical sites was found to be significant in the positive family history group. This difference was statistically significant (χ 2 = 15.47, p < 0.001). The prevalence of keloids in first-, second- and third-degree relatives of the proband with keloids was 7.62, 0.38 and 0.035 %, respectively. These results were higher than those in controls and the difference of the prevalence rates of first- and second-degree relatives between probands and controls was significant (χ 2 = 224.63 and 12.078, respectively, p < 0.001). The heritability of keloids in first-, second- and third-degree relatives was 72.45, 40.55 and 17.07 %, respectively. Our findings revealed that the most severe forms of keloids were observed in the probands with positive family history, and the heritability in first-degree relatives of probands was 72.45 %. It is certain, therefore, that genetic factors play a role in the hereditary composition of keloids.


Keloids Epidemiology Heritability 



We would like to thank the patients for participating in the study. This study was funded by the National Natural Youth Science Foundation (81101185).


  1. 1.
    Bayat A, Arscott G, Ollier WE, Ferguson MW, Mc Grouther DA (2004) Description of site-specific morphology of keloid phenotypes in an Afrocaribbean population. Br J Plast Surg 57(2):122–133CrossRefPubMedGoogle Scholar
  2. 2.
    Bayat A, McGrouther DA, Ferguson MW (2003) Skin scarring. BMJ 326(7380):88–92CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Bayat A, Arscott G, Ollier WE, McGrouther DA, Ferguson MW (2005) Keloid disease: clinical relevance of single versus multiple site scars. Br J Plast Surg 58(1):28–37CrossRefPubMedGoogle Scholar
  4. 4.
    Bock O, Schmid-Ott G, Malewski P, Mrowietz U (2006) Quality of life of patients with keloid and hypertrophic scarring. Arch Dermatol Res 297(10):433–438CrossRefPubMedGoogle Scholar
  5. 5.
    Bran GM, Goessler UR, Hormann K, Riedel F, Sadick H (2009) Keloids: current concepts of pathogenesis (review). Int J Mol Med 24(3):283–293CrossRefPubMedGoogle Scholar
  6. 6.
    Brissett AE, Sherris DA (2001) Scar contractures, hypertrophic scars, and keloids. Facial Plast Surg 17(4):263–272CrossRefPubMedGoogle Scholar
  7. 7.
    Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A (2008) The hidden cost of skin scars: quality of life after skin scarring. J Plast Reconstr Aesthet Surg 61(9):1049–1058CrossRefPubMedGoogle Scholar
  8. 8.
    Chipev CC, Simon M (2002) Phenotypic differences between dermal fibroblasts from different body sites determine their responses to tension and TGFbeta1. BMC Dermatol 2:13CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Datubo-Brown DD (1990) Keloids: a review of the literature. Br J Plast Surg 43(1):70–77CrossRefPubMedGoogle Scholar
  10. 10.
    Davies DM (1985) Plastic and reconstructive surgery. Scars, hypertrophic scars, and keloids. Br Med J (Clin Res Ed) 290(6474):1056–1058CrossRefGoogle Scholar
  11. 11.
    Emery AEH (1986) Methodology in medical genetics. Churchill Livingston, New YorkGoogle Scholar
  12. 12.
    English RS, Shenefelt PD (1999) Keloids and hypertrophic scars. Dermatol Surg 25(8):631–638CrossRefPubMedGoogle Scholar
  13. 13.
    Kazeem AA (1988) The immunological aspects of keloid tumor formation. J Surg Oncol 38(1):16–18CrossRefPubMedGoogle Scholar
  14. 14.
    Kelly AP (2004) Medical and surgical therapies for keloids. Dermatol Ther 17(2):212–218CrossRefPubMedGoogle Scholar
  15. 15.
    Kelly AP (1988) Keloids. Dermatol Clin 6(3):413–424PubMedGoogle Scholar
  16. 16.
    Kischer CW, Shetlar MR, Chvapil M (1982) Hypertrophic scars and keloids: a review and new concept concerning their origin. Scan Electron Microsc Pt 4:1699–1713PubMedGoogle Scholar
  17. 17.
    Louw L (2000) Keloids in rural black South Africans. Part 1: general overview and essential fatty acid hypotheses for keloid formation and prevention. Prostaglandins Leukot Essent Fatty Acids 63(5):237–245CrossRefPubMedGoogle Scholar
  18. 18.
    Lu WS, Cai LQ, Wang ZX, Li Y, Wang JF, Xiao FL, Quan C, He SM, Yang S, Zhang XJ (2010) Association of HLA class I alleles with keloids in Chinese Han individuals. Hum Immunol 71(4):418–422CrossRefPubMedGoogle Scholar
  19. 19.
    Marneros AG, Norris JE, Olsen BR, Reichenberger E (2001) Clinical genetics of familial keloids. Arch Dermatol 137(11):1429–1434CrossRefPubMedGoogle Scholar
  20. 20.
    Marneros AG, Norris JE, Watanabe S, Reichenberger E, Olsen BR (2004) Genome scans provide evidence for keloid susceptibility loci on chromosomes 2q23 and 7p11. J Invest Dermatol 122(5):1126–1132CrossRefPubMedGoogle Scholar
  21. 21.
    Nakashima M, Chung S, Takahashi A, Kamatani N, Kawaguchi T, Tsunoda T, Hosono N, Kubo M, Nakamura Y, Zembutsu H (2010) A genome-wide association study identifies four susceptibility loci for keloid in the Japanese population. Nat Genet 42(9):768–771CrossRefPubMedGoogle Scholar
  22. 22.
    Olaitan PB (2009) Keloids: assessment of effects and psychosocial-impacts on subjects in a black African population. Indian J Dermatol Venereol Leprol 75(4):368–372CrossRefPubMedGoogle Scholar
  23. 23.
    Omo-Dare P (1975) Genetic studies on keloid. J Natl Med Assoc 67(6):428–432PubMedCentralPubMedGoogle Scholar
  24. 24.
    Phan TT, Lim IJ, Bay BH, Qi R, Longaker MT, Lee ST, Huynh H (2003) Role of IGF system of mitogens in the induction of fibroblast proliferation by keloid-derived keratinocytes in vitro. Am J Physiol Cell Physiol 284(4):C860–C869CrossRefPubMedGoogle Scholar
  25. 25.
    Placik OJ, Lewis VL Jr (1992) Immunologic associations of keloids. Surg Gynecol Obstet 175(2):185–193PubMedGoogle Scholar
  26. 26.
    Ragoowansi R, Cornes PG, Moss AL, Glees JP (2003) Treatment of keloids by surgical excision and immediate postoperative single-fraction radiotherapy. Plast Reconstr Surg 111(6):1853–1859CrossRefPubMedGoogle Scholar
  27. 27.
    Ramakrishnan KM, Thomas KP, Sundararajan CR (1974) Study of 1,000 patients with keloids in South India. Plast Reconstr Surg 53(3):276–280CrossRefPubMedGoogle Scholar
  28. 28.
    Seifert O, Mrowietz U (2009) Keloid scarring: bench and bedside. Arch Dermatol Res 301(4):259–272CrossRefPubMedGoogle Scholar
  29. 29.
    Sharquie KE, Al-Dhalimi MA (2003) Keloid in Iraqi patients: a clinicohistopathologic study. Dermatol Surg 29(8):847–851PubMedGoogle Scholar
  30. 30.
    Shih B, Bayat A (2010) Genetics of keloid scarring. Arch Dermatol Res 302(5):319–339CrossRefPubMedGoogle Scholar
  31. 31.
    Thompson LD (2004) Skin keloid. Ear Nose Throat J 83(8):519PubMedGoogle Scholar
  32. 32.
    Ud-Din S, Thomas G, Morris J, Bayat A (2013) Photodynamic therapy: an innovative approach to the treatment of keloid disease evaluated using subjective and objective non-invasive tools. Arch Dermatol Res 305(3):205–214CrossRefPubMedGoogle Scholar
  33. 33.
    Urioste SS, Arndt KA, Dover JS (1999) Keloids and hypertrophic scars: review and treatment strategies. Semin Cutan Med Surg 18(2):159–171CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Wen-sheng Lu
    • 1
  • Xiao-dong Zheng
    • 2
  • Xiu-hua Yao
    • 1
  • Lan-fang Zhang
    • 1
  1. 1.Department of DermatologyAffiliated Provincial Hospital, Anhui Medical UniversityHefeiPeople’s Republic of China
  2. 2.Department of DermatologyAnhui Medical UniversityHefeiPeople’s Republic of China

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