Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

Definition

A keloid is a fleshy but firm raised area of skin. It develops when scar tissue from a healing injury, (eg, a deep skin wound) develops beyond the affected area. This results in a growth that can vary in size from one to several inches. Keloids are not harmful to general health.

Causes

For unknown reasons, scar tissue begins to form in an uncontrolled manner. Proteins continue to multiply after the wound has been covered. The process can continue for weeks or months. This is especially true for the following areas:

  • Earlobes
  • Shoulders
  • Upper back
  • Chest
  • Back of scalp and neck

Risk Factors

Factors that increase your chance of keloids include:

  • African American, Asian, or Hispanic ethnicity
  • Between 10-30 years old
  • Deep skin wounds, such as those from burns or surgical scars
  • Scars from acne, vaccinations, or chickenpox
  • Family history

Normal Surgical Scar

Post-operative scar
Ideally the scar tissue would stop developing at this point. With keloids, the scar tissue will grow beyond the borders of the original scar.
© 2011 Nucleus Medical Media, Inc.

Symptoms

Keloids often begin as small lumps at the site of a skin injury. They gradually grow beyond the margins of the original wound. Keloids do not go below the surface.

Symptoms include:

  • Pain
  • Burning
  • Itchiness
  • Tenderness

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

You may be referred to a specialist. Dermatologists focus on the skin. They can confirm the diagnosis and assist in removal. A plastic surgeon may do the removal.

Tests may include a biopsy. This may be done to rule out tumor formation or other skin disorders.

Treatment

In very rare cases, some keloids dissolve on their own. However, in those at risk for keloid formation, it is common for a keloid to reappear after it has been removed. The main goals of keloid treatment are to:

  • Remove the keloid to allow normal healing
  • Stop the discomfort caused by pain, burning, itchiness, or tenderness
  • Avoid recurrence
  • Minimize scarring

Treatment options may vary. Your doctor may recommend more than one depending on your condition.

Corticosteroid Injections

These are made directly into the skin lesion. They are repeated every 3-4 weeks for six months. Steroids relieve itching and pain. They can slow down collagen formation. This will cause the keloid to shrink. This procedure may be combined with surgery to remove any remaining lesion.

Compression Dressings

This process is used to apply pressure to the keloid. The pressure will flatten it. The dressing is reapplied every 7-10 days. The treatment may continue over a period of 3-12 months.

Surgery

Surgery may be done to remove the keloid. It is often done in combination with corticosteroid injections.

Cryosurgery

This method is used to freeze small, contained lesions. Cryosurgery may be done in combination with corticosteroid injections.

Radiation Therapy

This therapy is highly successful. It is limited due to the toxicities.

Interferon-alfa

These injections may reduce recurrence rates after surgery.

Intralesional Fluorouracil

This drug may be of benefit for keloids.

Imiquimod

This cream has been used to prevent regrowth of keloids after removal.

Prevention

To help reduce your chances of forming a keloid, take the following steps:

  • Avoid trauma to the skin.
  • Attend to cuts or abrasions immediately to minimize scarring.
  • Avoid elective cosmetic surgery.
  • Do not tattoo or pierce your ears or other areas of the body.