Skip to main content

Advertisement

SpringerLink
Log in

Keloid incidence in Asian people and its comorbidity with other fibrosis-related diseases: a nationwide population-based study

  • Original Paper
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Keloids is a fibroproliferative disease. The incidence of keloids among Asians has not been thoroughly studied. The objective of this study is to determine the incidence of keloids in Taiwan, which mainly consists of ethnic Chinese. Furthermore, we want to determine the comorbidity rate of other fibrosis-related diseases among keloid patients. This study was based on the National Health Insurance Research Database, which contains the data of 1 million randomly selected patients. Multivariate logistic regression analyses were employed to estimate the relative odds of keloids as a function of fibrosis-related diseases. The annual keloid incidence rate in Taiwan was 0.15 % for the general population. With a 1.33 ratio, women outnumbered men. Women with uterine leiomyoma have a 2.25-fold greater risk of keloids, compared with women without leiomyoma. We concluded that keloid incidence in Taiwan is approximately 0.15 %. Women with leiomyoma have a greater risk of keloids, this implicates that both diseases share a common etiopathological pathway.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Abergel RP, Pizzurro D, Meeker CA, Lask G, Matsuoka LY, Minor RR, Chu ML, Uitto J (1985) Biochemical composition of the connective tissue in keloids and analysis of collagen metabolism in keloid fibroblast cultures. J Invest Dermatol 84(5):384–390

    Article  PubMed  CAS  Google Scholar 

  2. Alhadya SM, Sivanantharajah K (1969) Keloids in various races a review of 175 cases. Plast Reconstr Surg 44(6):564–566

    Article  Google Scholar 

  3. Bae JM, Ha B, Lee H, Park CK, Kim HJ, Park YM (2012) Prevalence of common skin diseases and their associated factors among military personnel in Korea: a cross-sectional study. J Korean Med Sci 27(10):1248–1254

    Article  PubMed  PubMed Central  Google Scholar 

  4. Barrett J (1973) Keloid. In: Birth Defect Compendium. Williams and Wilken Company, Baltimore

  5. 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):28–37

    Article  PubMed  CAS  Google Scholar 

  6. Bayat A, Bock O, Mrowietz U, Ollier WE, Ferguson MW (2004) Genetic susceptibility to keloid disease: transforming growth factor beta receptor gene polymorphisms are not associated with keloid disease. Exp Dermatol 13(2):120–124

    Article  PubMed  CAS  Google Scholar 

  7. Brown JJ, Bayat A (2009) Genetic susceptibility to raised dermal scarring. Br J Dermatol 161(1):8–18

    Article  PubMed  CAS  Google Scholar 

  8. Brown JJ, Ollier WE, Thomson W, Bayat A (2008) Positive association of HLA-DRB1*15 with keloid disease in Caucasians. Int J Immunogenet 35(4–5):303–307

    Article  PubMed  CAS  Google Scholar 

  9. Carrino DA, Mesiano S, Barker NM, Hurd WW, Caplan AI (2012) Proteoglycans of uterine fibroids and keloid scars: similarity in their proteoglycan composition. Biochem J 443(2):361–368

    Article  PubMed  CAS  Google Scholar 

  10. Char F (1971) Ehlers-Danlos syndrome. Birth Defects Orig Artic Ser 7(8):300–302

    PubMed  CAS  Google Scholar 

  11. Chen GY, Cheng YW, Wang CY, Hsu TJ, Hsu MM, Yang PT, Chen WC (2008) Prevalence of skin diseases among schoolchildren in Magong, Penghu, Taiwan: a community-based clinical survey. J Formos Med Assoc 107(1):21–29

    Article  PubMed  Google Scholar 

  12. Cheng CL, Kao YHY, Lin SJ, Lee CH, Lai ML (2011) Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan. Pharmacoepidemiol Drug Saf 20(3):236–242

    Article  PubMed  Google Scholar 

  13. Chin GS, Liu W, Peled Z, Lee TY, Steinbrech DS, Hsu M, Longaker MT (2001) Differential expression of transforming growth factor-beta receptors I and II and activation of Smad 3 in keloid fibroblasts. Plast Reconstr Surg 108(2):423–429

    Article  PubMed  CAS  Google Scholar 

  14. Cosman B, Crikelair GF, Ju DMC, Gaulin JC, Lattes R (1961) The surgical treatment of keloids. Plast Reconstr Surg 27(4):335–358

    Article  Google Scholar 

  15. De Nicola A, Mancuso P, Valdmanis V (2013) Quality and health care performance in the Italian regions. Munich Personal RePEc Archive. http://mpra.ub.uni-muenchen.de/50495/. Accessed 15 Jul 2014

  16. Fisher ES, Whaley FS, Krushat WM, Malenka DJ, Fleming C, Baron JA, Hsia DC (1992) The accuracy of Medicare’s hospital claims data: progress has been made, but problems remain. Am J Public Health 82(2):243–248

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  17. Flake GP, Andersen J, Dixon D (2003) Etiology and pathogenesis of uterine leiomyomas: a review. Environ Health Perspect 111(8):1037–1054

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  18. Hambrick GW Jr, Carter DM (1966) Pachydermoperiostosis. Touraine-Solente-Gole syndrome. Arch Dermatol 94(5):594–607

    Article  PubMed  Google Scholar 

  19. Hoekstra AV, Sefton EC, Berry E, Lu Z, Hardt J, Marsh E, Yin P, Clardy J, Chakravarti D, Bulun S, Kim JJ (2009) Progestins activate the AKT pathway in leiomyoma cells and promote survival. J Clin Endocrinol Metab 94(5):1768–1774

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  20. Iwahashi M, Muragaki Y (2011) Increased type I and V collagen expression in uterine leiomyomas during the menstrual cycle. Fertil Steril 95(6):2137–2139

    Article  PubMed  CAS  Google Scholar 

  21. James WD, Berger TG, Butler DF, Tuffanelli DL (1984) Nodular (keloidal) scleroderma. J Am Acad Dermatol 11(6):1111–1114

    Article  PubMed  CAS  Google Scholar 

  22. Ketchum LD, Cohen IK, Masters FW (1974) Hypertrophic scars and keloids. A collective review. Plast Reconstr Surg 53(2):140–154

    Article  PubMed  CAS  Google Scholar 

  23. Kiyota Y, Schneeweiss S, Glynn RJ, Cannuscio CC, Avorn J, Solomon DH (2004) Accuracy of medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital records. Am Heart J 148(1):99–104

    Article  PubMed  Google Scholar 

  24. Ko CW, Dominitz JA, Green P, Kreuter W, Baldwin LM (2011) Accuracy of medicare claims for identifying findings and procedures performed during colonoscopy. Gastrointest Endosc 73(3):447–453

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lee TY, Chin GS, Kim WJ, Chau D, Gittes GK, Longaker MT (1999) Expression of transforming growth factor beta 1, 2, and 3 proteins in keloids. Ann Plast Surg 43(2):179–184

    PubMed  CAS  Google Scholar 

  26. Leppert PC, Catherino WH, Segars JH (2006) A new hypothesis about the origin of uterine fibroids based on gene expression profiling with microarrays. Am J Obstet Gynecol 195(2):415–420

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  27. Lin CC, Lai MS, Syu CY, Chang SC, Tseng FY (2005) Accuracy of diabetes diagnosis in health insurance claims data in Taiwan. J Formos Med Assoc 104(3):157–163

    PubMed  Google Scholar 

  28. Lu WS, Wang JF, Yang S, Xiao FL, Quan C, Cheng H, Wang PG, Zhang AP, Cai LQ, Zhang XJ (2008) Association of HLA-DQA1 and DQB1 alleles with keloids in Chinese Hans. J Dermatol Sci 52(2):108–117

    Article  PubMed  CAS  Google Scholar 

  29. 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):1126–1132

    Article  PubMed  CAS  Google Scholar 

  30. Moustafa MF, Abdel-Fattah MA, Abdel-Fattah DC (1975) Presumptive evidence of the effect of pregnancy estrogens on keloid growth. Case report. Plast Reconstr Surg 56(4):450–453

    Article  PubMed  CAS  Google Scholar 

  31. Oluwasanmi JO (1974) keloids in the African. Clin Plast Surg 1(1):179–195

    PubMed  CAS  Google Scholar 

  32. Phan TT, Lim IJ, Aalami O, Lorget F, Khoo A, Tan EK, Mukhopadhyay A, Longaker MT (2005) Smad3 signalling plays an important role in keloid pathogenesis via epithelial-mesenchymal interactions. J Pathol 207(2):232–242

    Article  PubMed  CAS  Google Scholar 

  33. Pohlers D, Brenmoehl J, Loffler I, Muller CK, Leipner C, Schultze-Mosgau S, Stallmach A, Kinne RW, Wolf G (2009) TGF-beta and fibrosis in different organs—molecular pathway imprints. Biochim Biophys Acta 1792(8):746–756

    Article  PubMed  CAS  Google Scholar 

  34. Ramakrishnan KM, Thomas KP, Sundararajan CR (1974) Study of 1,000 patients with keloids in South India. Plast Reconstr Surg 53(3):276–280

    Article  PubMed  CAS  Google Scholar 

  35. Rockwell WB, Cohen IK, Ehrlich HP (1989) Keloids and hypertrophic scars: a comprehensive review. Plast Reconstr Surg 84(5):827–837

    Article  PubMed  CAS  Google Scholar 

  36. Shih B, Bayat A (2010) Genetics of keloid scarring. Arch Dermatol Res 302(5):319–339

    Article  PubMed  CAS  Google Scholar 

  37. Shih B, Bayat A (2012) Comparative genomic hybridisation analysis of keloid tissue in Caucasians suggests possible involvement of HLA-DRB5 in disease pathogenesis. Arch Dermatol Res 304(3):241–249

    Article  PubMed  CAS  Google Scholar 

  38. Shoemaker JF (1901) A practical treatise on disease of the skin. Appleton, New York

    Google Scholar 

  39. Siraganian PA, Rubinstein JH, Miller RW (1989) Keloids and neoplasms in the Rubinstein-Taybi syndrome. Med Pediatr Oncol 17(6):485–491

    PubMed  CAS  Google Scholar 

  40. Stewart EA, Friedman AJ, Peck K, Nowak RA (1994) Relative overexpression of collagen type I and collagen type III messenger ribonucleic acids by uterine leiomyomas during the proliferative phase of the menstrual cycle. J Clin Endocrinol Metab 79(3):900–906

    PubMed  CAS  Google Scholar 

  41. Syed F, Bagabir RA, Paus R, Bayat A (2013) Ex vivo evaluation of antifibrotic compounds in skin scarring: EGCG and silencing of PAI-1 independently inhibit growth and induce keloid shrinkage. Lab Invest 93(8):946–960

    Article  PubMed  CAS  Google Scholar 

  42. Uitto J, Perejda AJ, Abergel RP, Chu ML, Ramirez F (1985) Altered steady-state ratio of type I/III procollagen mRNAs correlates with selectively increased type I procollagen biosynthesis in cultured keloid fibroblasts. Proc Natl Acad Sci USA 82(17):5935–5939

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  43. Vargas L Jr (1943) Attempt to induce formation of fibroids with estrogen, in the castrated female rhesus monkey. Bull Johns Hopkins Hosp 73(1):23–28

    PubMed  CAS  Google Scholar 

  44. Walker SL, Shah M, Hubbard VG, Pradhan HM, Ghimire M (2008) Skin disease is common in rural Nepal: results of a point prevalence study. Br J Dermatol 158(2):334–338

    PubMed  CAS  Google Scholar 

  45. Yan X, Gao JH, Chen Y, Song M, Liu XJ (2007) Preliminary linkage analysis and mapping of keloid susceptibility locus in a Chinese pedigree. Zhonghua Zheng Xing Wai Ke Za Zhi 23(1):32–35

    PubMed  Google Scholar 

  46. Yang YC, Cheng YW, Lai CS, Chen W (2007) Prevalence of childhood acne, ephelides, warts, atopic dermatitis, psoriasis, alopecia areata and keloid in Kaohsiung County, Taiwan: a community-based clinical survey. J Eur Acad Dermatol Venereol 21(5):643–649

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Mr. Li-Zhou Yeh for his expert assistance with the structured query language programming related to the NHIRD.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, No. 250, Wuxin St., Taipei, 11031, Taiwan

    Lei-Ming Sun & Yuan-Chii G. Lee

  2. Department of Dermatology, Taipei Medical University Hospital, No. 252, Wuxin St., Taipei, Taiwan

    Kuo-Hsien Wang

Authors
  1. Lei-Ming Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kuo-Hsien Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuan-Chii G. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuan-Chii G. Lee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sun, LM., Wang, KH. & Lee, YC.G. Keloid incidence in Asian people and its comorbidity with other fibrosis-related diseases: a nationwide population-based study. Arch Dermatol Res 306, 803–808 (2014). https://doi.org/10.1007/s00403-014-1491-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-014-1491-5

Keywords

Search

Navigation