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Fig. 1. The 15 questions of the head-and-neck keloid quality of life questionnaire, representing 21 data points.

because of a change in the appearance of the keloid. In addition to the physical changes, 10 (25%) patients sought care because of problems with the patient’s social life, four (10%) because of problems at work or school, two (5%) because of family urging, and 12 (30%) was for some other reason (Table I). There were four subscales evaluated within the total scale, including physical symptoms, self-esteem, social functioning, and medical motivation. The test- retest correlation between visits 1 and 2 and visits 2 and 3 for physical symptoms was 0.65 and 0.19, respec- tively; for self-esteem was 0.68 and 0.81, respectively; for social functioning was 0.83 and 0.52, respectively; for medical motivation was 0.65 and 0.55, respectively; and finally, for the total scale was 0.70 and 0.77, respectively (Table II). The Cronbach’s alpha, which represents internal consistency of each subscale and the whole scale, was 0.66 for medical motivation, 0.86 for physical symptoms, 0.77 for self-esteem, 0.70 for social functioning, and 0.87 for the entire scale (Table III). To determine the relationship between each sub- scale’s assessment of QOL to the assessment obtained by the entire questionnaire, a Pearson correlation was used. The Pearson correlation between the MMS to the

Cronbach’s alpha. Statistical analysis was performed using STATA version 11 (StataCorp Lp, College Station, TX).

RESULTS A total of 40 patients were enrolled in the study. The average age of the patients at the time of enroll- ment was 29.1 (range 15–56), with the average age of development of the first keloid at 17.1 (range 1–55). Sev- enteen (42.5%) patients self-identified as black, 13 (32.5%) as African, six (15%) as Hispanic, three (7.5%) each as Caucasian or Asian, and one (2.5%) as other. The majority of patients had keloids isolated to only the head and neck (27, 67.5%). The most common other loca- tion was the chest (7, 17.5%), back (4, 10%), arms (4, 10%), and legs (1, 2.5%). Piercings were the most fre- quent etiology (25, 62.5%), followed by surgery (7, 17.5%), cuts (3, 7.5%), and acne scars (2, 5%); in five (12.5%) patients the etiology was unknown. Most patients had received some form of previous treatment, including steroid injections (26, 65.5%), surgi- cal excision (18, 45%), radiation (3, 7.5%), and laser ther- apy (2, 5%). The reasons for seeking care varied: 24 (60%) because the keloids were growing, 19 (47.5%) because the keloids became painful, and 16 (40%)

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