Androgen Receptors and Keloid Treatment in Children: Insights on Androgen Insensitivity Syndrome

Background: Keloids can form from an overgrowth of skin fibroblasts where the scar tissue extends beyond the initial boundaries of the injury; they are benign lesions. Studies indicated that androgens could influence these fibroblasts to cause excessive collagen deposition causing keloid formation (1). We aim to look at surgical and non-surgical management of keloids in children and to explore pain management during keloid treatment in children. Methods: A systematic search was conducted using Medline, Embase, PubMed and Cochrane Library looking into the different keloid treatments used in children. As there were limited studies looking into pain management in children, an exclusion was made to investigate adult (age>18 years) studies. We hypothesized that the use of surgical and adjuvant therapy is better for steroid treatment. Results: Out of the 33 abstracts, 21 articles fit the inclusion criteria. Conclusion: Non-surgical treatments such as intralesional triamcinolone acetonide (TCA) and Botulinum toxin Type A reduced the volume of keloids up to around 80%. A combination therapy is safer with fewer side effects in the paediatric population. A study has also suggested the use of anti-androgenic treatment such as Finasteride or Combined Oral Contraceptives can help to reduce inflammation within the skin and provide ‘long-term’ health benefits to those predisposed to keloids. Surgical and non- surgical treatment (including anti-androgenic treatment) may be used in those who develop keloids after gender affirming surgeries in those with conditions such as Androgen Insensitivity Syndrome (2). Further studies are required to understand the multimodal therapy that can be used to treat keloids in children.