How we reside above stigma, emotional misery– Nigerians with keloids

JANET OGUNDEPO writes on the ordeal of persons with raised, bulging scars, known as keloids; and their constant battles with stigma and low self-esteem amid their quest to seek permanent treatment.

Daily, Chidera Okoliezike, a graphic designer, grapples with a hidden battle that has almost stripped him of his self-esteem. He nurses a huge scar at the base of his neck; one that earns him curious, embarrassing glances from people.

Five years ago, what began as a small, harmless cut from his clipper when he went to trim his lush beard, in no time, festered into sores and scars that defied treatment.

The incident took place precisely in 2019 and Okoliezike, who prefers to be called Dera, told our correspondent that he applied all sorts of medications to the wound, hoping for a swift recovery.

Though he got a reprieve, it, however, turned out to be temporal because as weeks passed, the scar resurfaced, spreading its tentacles across his jaw and neck.

Left puzzled by the mysterious bumps, the young man wondered how he would navigate through life with the conspicuous mounds of shiny flesh that had spread to his face.

Doctors would later diagnose them as keloids, a condition in which scars grow out of control, defying the body’s natural healing process.

 In January 2020, Dera, as he is fondly called, sought help at a government hospital in Lagos to have the bumps surgically removed.

Sadly, the keloids doubled their original sizes weeks after the operation.

The graphic designer recalled being told before the surgery that the bump “has a high chance of reoccurrence and increasing in size.”

And true to the doctor’s words, his jaw and neck have big keloids etched like birthmarks, challenging his self-esteem and resilience.

As Dera painstakingly continue in his search for a permanent cure, he joins countless others in this torturous quest.

Keloids, a growing monster

The American Academy of Dermatology Association illuminates this perplexing phenomenon, noting that Keloids are a type of raised scar.

However, unlike other raised scars, keloids grow slowly for months or years, becoming bigger and bigger than the initial wound that caused the scar.

 In addition, the AAD indicates that while keloids can affect people of all backgrounds, black individuals face a higher risk.

Keloids typically emerge from skin injuries, cuts, piercings, surgeries, or biopsies. However, as experts from According Healthwise pointed out, not everybody with an injury is predisposed to keloids, as genetic factors and familial traits play major roles.

Growing bump, low self-esteem

But beyond biology lies a deeper struggle, stigma, which stems from the belief that the condition is contagious.

However, experts decried the stigma faced by those with the condition, asserting that it is not contagious.

The fact that Dera’s keloids defy concealment and are strategically positioned so they cannot be shielded by clothing, makes him the butt of jokes and segregation.

He said gloomily, “Due to the size and spread of the keloids on my jaw, I usually get stares in public. This is coupled with the stigma that comes with the condition.

“My confidence and self-esteem have been shattered. Sometimes, while interacting with people, I can’t meet their gaze. My head is always bowed because of my face. As a result, depression set in because I couldn’t interact with people.

“Adults and children alike cast unspoken glances at me. They don’t say anything but I see their reactions. They look at me with this shocked expression, trying to understand what’s on my face.”

To mitigate the stares, the graphic designer turned keloids awareness advocate, told According Healthwise that for some time now, he wears different types of masks to stop the unveiled look of disgust or unnecessary questioning directed at him.

He added, “I also choose clothes carefully to conceal the keloids on my chest when visitors arrive. But most people now know that I have the condition.”

Dera revealed that aside from the keloids on his face, he now has them sprouting sporadically on his chest and shoulders.

“It is not as a result of barbing. They just started developing, and I have no idea how they came about,” he said with a shocked expression.

The quest for a cure remains elusive. Each day when Dera stares at himself in the mirror, he is faced with both physical and emotional distress.

He describes the emotions as bittersweet, adding, “Some days, I almost forget that I have them, and on some other days, I am overly conscious about them and want them out. The mood is not certain.”

The graphic artist said he has no plan to undergo another surgery to clear the keloids and has left them to grow until he is sure of a permanent.

Keloids Vs. Hypertrophic Scars

In a 2020 study by Nkemcho Ojeh et al., “Keloids: Current and emerging therapies,” it was noted that keloids frequently recur and do not reduce in size.

The research further noted that, unlike ordinary scars, keloids refuse to shrink and persist, defying the body’s natural course.

These aesthetically disfiguring mounds can be painful, itchy, and emotionally taxing, study author noted, adding that their origin remains elusive, yet they are more common among Africans, Asians, and Hispanics with darker pigmentation.

Burden of keloids more on females

Though men and women face equal risks of having keloids, females bear a heavier burden as piercings and other triggers elevate their vulnerability.

Genetic factors such as having blood type A and falling into the age bracket of 10 to 30, are also factors.

However, several articles indicate that not all raised scars are keloids as they could be hypertrophic scars, which can regress after six months or a year without treatment, while keloids will require therapy to regress.

According to the health blog, SkinCancer.net, keloids are not cancerous and do not affect the overall health of affected individuals.

It, however, noted that it could affect the mental health of individuals, causing them some physical discomfort and concerns about their physical appearance.

Unknown growing scar

Ese Abohwo, now 28, carries a permanent reminder etched on her skin of an ordeal she suffered years ago as a teenager.

She remembers that the scar came to be after she sustained an injury from the flogging a relative meted on her whilst in secondary school.

The wound healed but left behind a scar that began to swell and increase in size.

Abohwo recalled that at 15, she noticed that new bumps had spouted in several parts of her body but kept her discovery a secret, to avoid being stigmatised.

Over time, she summoned courage and confided in a close relative, who consulted a doctor and antibiotics were prescribed.

Yet, the situation remained unchanged and undiagnosed.

In 2018, she noticed that after the acne on her face cleared, it formed a long line of raised scars.

When she visited a dermatologist, Abohwo was told the raised scars and growing bumps were keloids.

Ese also said has learnt to cope with the constant stares and glances people throw at her, coupled with several unsolicited advice and suggestions that bother effective cure.

“People would always wonder what happened to my face. But I later understood that the stares were not malicious, as even a child would ask to want to know what happened to me.

“I didn’t know that it was keloids. When I travelled out of Nigeria, I met with a doctor who told me it was keloids for the first time. However, the most prominent one is when, in 2018, more keloids started growing on my face due to acne stress.

“It started growing a little bit, then it formed into long-line keloids,” Abohwo told According Healthwise.

The outbreak of COVID-19 and the compulsory use of face masks were blessings in disguise for her, she told AccordingHealthwise.

According to her, facemasks provided the perfect opportunity to cover her face.

Abohwo noted that this offered relief from the constant stares she received in public and the stress of having to hide that part of her face with hair.

 “I covered my face with masks until I dared to go to a dermatologist. But for a long time, it was always there, and people would continue to ask me what the issue was.

“I was happy to wear the face mask and was in love with it. But when we no longer wore it, I arranged my hair in a way that would cover my face. So, I did a lot of covering and hiding,” she added.

However, wearing the face mask and covering the scars with her hair to reduce the stares did not help the keloids.

Rather, they began to itch badly due to the heat and increased in size.

Thankfully, Abohwo’s dermatologist found a treatment that drastically reduced the keloids.

She is currently an advocate for increased keloid awareness and desires to stop the stigmatisation of keloid warriors.

Long Term Battles

Some people with keloids, who were bold enough to share their stories on social media decried the stigma and public scrutiny they faced while in  constant search of a permanent cure.

Among them is Kesha, who shared her story on a Keloid support group on Instagram.

She revealed that her battle with keloids began at the age of 10 after a minor accident left her with a small scar.

Surgery followed, but the scar defied treatment, swelling into prominence.

Kesha, who is now married with children, said she went through secondary school with a facial scar that defied medical intervention and made her feel different from other kids.

Posting her pictures on the group, Kesha showed raised scars that formed from her left ear lobe down to her jaw, and the little patches scattered on her chest.

 “I had a second surgery where it was sliced and not stitched, and it made it spread and became bigger,” she wrote.

“I decided to just give up on getting it removed. But then I came down with chicken pox, and I got many more on my back.

“I tried to use creams and patches, but they didn’t work. I used Vitamin E oil, which helped to soothe the itching. When they get inflamed, I use lemon juice, which helps to calm them down.

“What else can I say? I have tried steroid injections, and they are so painful,” she lamented.

Surgery Not Cure For Keloids – Experts

Experts who spoke with According Healthwise noted that corticosteroids are the lasting treatment for the condition but that they could still recur.

According to Medical News Today, Corticosteroids are a class of drugs that can reduce inflammation.

Meanwhile, in a recent statement, Professor Ademola Olaitan, a specialist surgeon and researcher, who focuses on facial keloids, shed light on the factors contributing to keloid formation.

According to him, a familial history of keloids, genetic factors in blacks and Asians, and injuries that take a long time to heal are some predisposing factors for keloids.

He said, “Individuals who experience burns, such as acid or chemical burns, are more prone to developing keloids. Deep injuries or those resulting in significant tissue loss also create conditions favourable for keloid formation. The body’s attempt to repair such injuries through collagen production can lead to the development of keloids.”

Olaitan confirmed that keloids may be more prevalent among females, possibly due to their exposure to certain types of injuries, especially piercings.

Further speaking on the challenges of keloid treatment, the facial surgery specialist revealed that operation alone cannot provide a cure for keloids.

The expert explained, “While the body typically heals wounds with minimal scarring, individuals prone to keloids experience abnormal collagen growth, leading to persistent and enlarging scars.

“So, when surgery is done to remove it, it is as if one is provoking it because, by the time the body is healing itself, the collagen that is supposed to form and complete the repair will continue to increase.

“If the surgery is done initially to reduce the growth by one inch or one centimetre, the keloids will grow to about 1.2 to 1.5cm. If cut, the next one will grow 2cm to 3cm. So, surgery doesn’t cure it and is not an optional treatment for keloids.”

Keloids can only be managed,

The specialist said, however, that there is good news; keloids are not incurable as recent research indicates that while complete eradication may not be achievable, effective management and control strategies exist.

Olaitan explained, “Many people were not able to control it in the past because they were not given the appropriate medication at the appropriate time and interval. We have used radiation to treat keloids and achieved some results, but after some time, it would return.

“We have used corticosteroid to treat keloids because it was used in the past, but a particular amount should be dropped in particular keloids for it to shrink. If the appropriate amount is not given, it will seem like the corticosteroid is not working. But we have been able to get a regent that would drop the appropriate amount of corticosteroid at the appropriate interval and time, and we have achieved results.”

He further urged individuals with a family history of keloids to avoid having injuries, wounds, cuts, incisions, or piercings to prevent the formation of keloids.

The surgeon noted that persons prone to keloids and in need of surgery should do so as soon as possible and, after the surgery, begin the use of steroids to ensure the keloid formation is reduced.

He, however, decried the stigma persons with keloids face in society, stating that the condition is not an infectious disease.

The don urged persons with keloids to go to the appropriate health facilities for adequate care.

‘Keloids affect quality of life’

Also, a dermatologist working with the NHS in the United Kingdom, Dr Abiodun Alo, stated that keloid is a difficult condition to manage and that several studies have shown that persons with the condition have their quality of life affected.

She added, “Many things are still unclear with this condition. So, some of the things we talk about are just postulations. For example, people who are black are predisposed to keloids. It is also more common in the younger age groups due to some hormonal factors and because they are more predisposed to injuries.

“So, anything that can cause an injury on the body leading to wound healing and scar formation can cause keloids, especially in those predisposed to it. Also, those with a family member who has keloids are predisposed to the formation. However, some people without a family history of keloids are still predisposed to having it.”

The dermatologist advised those who are more prone to keloids to avoid sustaining injuries, having extra ear piercings, tattoos, and pimples popping.

“It is also important that persons with keloids avoid injuries to prevent having more formations on other parts of the body and to seek medical help,” she further advised.

Additionally, the skin doctor said total keloid treatment or eradication is difficult to achieve, and several approaches are currently in use.

She stated, “One method that is commonly used is injections, where individuals with keloids are injected with steroids or other stronger medication. There’s also radiotherapy, laser treatment, and surgical removal. However, removing it surgically creates another wound, which predisposes the person to another keloid formation.

“So, when we remove it through surgery, some weeks after removing it, we inject a type of injection called steroid so that it helps to suppress the keloids from forming. Although all these treatments have side effects, they are told to the individual who decides the type of treatment they want.”

 She decried the stigmatisation of persons with keloids and urged the public to show empathy and understanding to them.

The dermatologist urged individuals to treat any injury or wound properly to prevent keloid formation.