Determinants of Keloid recurrence: The Nairobi keloid recurrence scoring system; A cohort, prospective study

Abstract Background Keloid disease is a fibro-proliferative disorder characterized by excessive deposition of collagen. Keloids has shown high recurrence rate. We undertook this study to determine what factors influence recurrence of the disease with the aim of developing a keloid recurrence scoring system. Methods This was a cohort prospective longitudinal study of patients who presented with keloids, managed by surgical excision followed by post excision radiotherapy. Post-surgery patients were followed up for at least two years to determine recurrence. Variables analyzed included patients’ history, clinical presentation and keloid histology. Data captured were analyzed using SPSS version 21. Student T-test and Chi-square test were used to compare means and frequencies respectively at 95% confidence level (P-Value <0.05). Multi regression analysis was done to determine the contributions of various variables to keloid recurrence. Results Ninety patients were followed up in the study for duration of two years. Overall keloid recurrence was 21% with male patients having a significantly higher recurrence rate of 31% compared to the female at 12%. The recurrence rates were also higher in familial keloids at 27.7% compared to sporadic keloids at 18.5%. Other factors that influenced recurrence included anatomical location, patient’s blood group and histological composition of the keloid. Multiple regression analysis done demonstrated that gender and family history was the biggest contributor to keloid recurrence. Conclusion Keloid recurrence is influenced by many factors including family history, clinical presentation and keloid histology. A Keloid recurrence scoring system encompassing these factors could assist in the determination of post excision management as well as prediction of the likelihood of recurrence. Highlights