Relief of Keloid-associated Symptoms by Topical Application of Thin Plastic Sheets.

Dear Editor,

An 86-year-old man of Chinese descent has harbored a chronic keloid on the front of his chest wall since the age of 33.[1] His keloid developed after the excision of a small sebaceous cyst 53 years ago. Over the years, tightness, tenderness, pain, and pruritus over the keloid were common occurrences.[1] Successful treatment of those symptoms in our patient has included the topical applications of silicone gel sheets geared for use in keloid management.[1] Three years ago, however, for 2 months, instead of applying silicone gel sheets, the patient decided to experiment with the application of a variety of conventional, thin, plastic sheets [Figure 1], ordinarily used for wrapping food or other items for coverage or storage. These plastic sheets, readily available commercially, were of different composition (such as polyethylene and polyvinyl chloride). The duration of each application varied from 12 to 16 h. Immediate relief of tightness, tenderness, pain, and pruritus from the application of these plastic sheets could be achieved. The improvement only ended with the completion of each application.

Figure 1

A conventional plastic sheet covering a keloid on the patient's chest wall. 1 inch = 2.54 cm

During the experiment, the patient did not receive other forms of anti-keloid therapy. During this experimental period, the keloid did not increase or decrease in size while no complications of the sheeting were encountered. One precautionary measure that the patient heeded very much was that, in the face of hot weather or severe exercise, the duration of sheeting would be much shortened and the rest period (i.e., the non-sheeting period) prolonged in order to avoid infections involving the keloid as a result of sweat-induced skin sogginess.[1] Abscess formation at the site of a keloid has occurred in hot weather after silicone gel sheeting.[1]

Recently, Ogawa has suggested that the use of silicone devices can reduce tensile stresses in a wound environment.[2] In agreement with Ogawa, we are of the opinion that reducing tissue tension is the reason why thin plastic sheets could offer relief to keloid-related symptoms. Moreover, it has been found that the use of a variety of tapes, such as that of paper tapes, could assist also in the management of keloids (such as in terms of keloid development),[34] a situation probably related to the lowering of mechanical tissue tension too. Finally, we believe that pressure therapy, a well-recognized approach of keloid management, derives its beneficial effects from the same tissue tension reduction principle.[5]

In conclusion, we have found that thin, readily available, inexpensive plastic sheets could, in common with silicone devices, relieve keloid-related symptoms. We believe that the favorable effects are related to the curbing of tissue tension. We present this case in the hope of helping to offer some light to the therapeutic principle underlying the covering of a keloid. Whether this method of thin plastic sheet application might turn out to be a useful tool in the armamentarium of a dermatologist depends on if the technique is found by other centers to be a satisfactory approach.

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Nil.

Conflicts of interest

There are no conflicts of interest.