Keloid Scars: The Hidden Burden of Disease

Background: Keloid scar patients are known to present with a combination of symptoms including pain, physical deformity and psychological distress. These three facets that characterise the full extent of the keloid disease (KD) have not been validated in a clinical setting before as a whole and thus the disease is usually approached and managed incompletely. Assessment measures need to accurately quantify the disease’s impact on the patients’ distress in terms of physical symptoms, life quality and psychosocial status. Method: 46 keloid scar patients seen at clinic were asked to fill out the MSF-PQ, DLQI and DAS-24 questionnaires. The results were analysed for internal consistency (IC) and convergent validity (CV). Each of the three questionnaires was then further analysed to identify factors which affect patients with the disease. Results: There was convergent validity between DAS-24 and DLQI scores (0.54, p<0.01). The questionnaires showed excellent IC (α-range 0.86-0.9). Female gender and the presence of scars hidden under the clothesline significantly increased patients’ pain (MSF-PQ) and QoL impact scores (DLQI). All questionnaires showed good validity in assessing the aspects of concern for keloid scar patients, severity of physical symptoms and capturing patient’s subjective feelings and avoidance behaviours. Conclusion: KD extends beyond being a hyper-proliferative disease of scars. The resulting lesions can produce disabling symptoms, deforming growths and a level of appearance anxiety whether visible or not. Assessing the extent of the disease and its effects on the patient, by the proposed, validated assessment tools, highlights the need for a more complete management of the disease.