The Association Between Race/Ethnicity and Keloid Formation: A Network Meta-Analysis.

BACKGROUND: Keloids are benign, fibroproliferative skin lesions due to abnormal wound healing. While keloid formation disproportionately varies by race and ethnicity, epidemiological data on racial and ethnic differences remain fragmented. This study aimed to quantitatively compare keloid prevalence among different racial and ethnic groups. METHODS: A systematic literature search identified keloid prevalence among different racial (White, Black, Asian, Unknown, and Other/Mixed) and ethnic (Hispanic/Latinx and non-Hispanic/Latinx) groups (CRD420251113908). Pairwise comparisons using a random-effects model and a network meta-analysis were conducted. RESULTS: Eight studies were included in the network meta-analysis on race, encompassing 31,964 keloids and 373,390 nonkeloids. Compared to White individuals, pooled odds ratio (OR) was highest among Black individuals (OR = 6.14; 95% CI: 3.75-10.07), followed by Asian individuals (OR = 3.70; 95% CI: 2.16-6.34), Unknown race (OR = 1.94; 95% CI: 1.06-3.54), and Other/Mixed (OR = 1.93; 95% CI: 1.07-3.49). Four studies were included for the pairwise analysis on ethnicity. Pooled OR of keloid prevalence comparing Hispanic/Latinx with non-Hispanic/Latinx was 1.12 (95% CI 0.41-3.03). CONCLUSIONS: This study demonstrates a statistically significant association between race and keloid formation, with greater odds of keloid formation among Black and Asian individuals compared to White individuals. No statistical difference was demonstrated between ethnic groups, although findings were underpowered. Findings support race as an important risk factor for keloid development, further informing prevention strategies, patient counselling, and practices to provide equitable care.