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A keloid results when a healing skin injury produces excess connective tissue that extends beyond the confines of the original wound1 and which tends to recur after excision. Keloids were first described centuries ago in the Smith papyrus, later in 1770 by Retz, and in 1802 by Alibert, 2–4 who proposed the current name. Their exact etiology and nature are not known,5 and a universally effective treatment has not been found. Developments in wound healing and collagen metabolism have provided insight and direction to the process, but better understanding of its biochemistry and cellular physiology is necessary before improved treatment can be found.