Psychological Assessment of Anxiety and Depression in Patients with Single versus Multiple Keloids: A Cross-Sectional Study

BACKGROUND

Keloids are chronic fibroproliferative disorders that cause significant physical disfigurement and psychological distress. While the psychosocial burden of keloids is documented, the differential impact of lesion multiplicity remains unclear.

OBJECTIVE

To compare anxiety and depression levels in patients with single versus multiple keloids and analyze correlations with physical symptoms.

METHODS

This cross-sectional study enrolled 758 patients (274 single, 484 multiple lesions). Psychological status was assessed using the Hospital Anxiety and Depression Scale (HADS), including anxiety (SAS) and depression (SDS) subscales. Physical symptoms were evaluated using the Vancouver Scar Scale (VSS) and Visual Analog Scale (VAS).

RESULTS

Patients with multiple keloids (MK) had significantly higher SDS scores (4.80 ± 3.01) compared to single keloid patients (SK, 4.16± 2.89, p= 0.003). SAS scores were higher in the multiple group but did not reach statistical significance (p= 0.06). Conversely, SK patients reported significantly higher physical symptom scores (VSS: 10.78 ± 2.81 vs.10.10 ± 3.14, p<0.001; VAS: 4.73 ± 2.29 vs.4.21 ± 2.08, p<0.001). No significant correlation was found between psychological and physical scores (r < 0.05).

CONCLUSION

Multiplicity of lesions is a significant, independent risk factor for depression in keloid patients, dissociated from physical symptom severity.