Keloids gradually change their shapes as they grow. We hypothesize that the change of keloid morphology reflects the incremental change of the stress patterns occurring in peri-keloid regions due to movement of the keloid-carrying body part. To examine the validity of this hypothesis, we used three-dimensional finite element analysis to calculate the stresses occurring in the peri-keloid regions of keloids on the chest in response to respiratory movement. The stresses concentrate at the peri-keloid regions close to the bilateral ends of the keloids. By reviewing this result in reference to our hypothesis, we can explain why keloids on the chest are likely to present crab or butterfly shapes. Although we know that keloids grow in response to mechanical stresses, our hypothesis differs from existing ones in that it focuses on morphological transformation. Our hypothesis is helpful for physicians in performing treatment for keloids, because they can predict what part of a keloid is likely to grow and perform preventive treatment in reference to the hypothesis.
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