Keloids

About

Keloids

What are keloids?

Keloids are one type of scar that can develop after an injury, piercing, burn, tattoo, severe acne, chickenpox or surgery. Anything that can cause a scar can develop into a keloid. However, it’s uncommon for scars to develop into a keloid. They are more likely to develop on people with dark skin. Spontaneous keloids, while very rare, can form where there is no injury. Keloids don’t affect your overall health and are not cancerous. They are most common on the chest, shoulders, earlobes and cheeks, but can develop anywhere. If the keloid is in a prominent area of your body, it may be something you’d like to have removed. There are several treatments available from your dermatologist, and not every treatment works for every keloid. Even after removal, keloids can come back.

Should I be concerned about keloids?

Probably not. They are not cancerous, nor are they contagious. If the appearance bothers you, or restricts movement, you may want to have it removed.

Causes

What causes keloids?

When the skin’s surface is broken by an injury or burn, fibrous tissue grows over the wound to start the repair process and to protect the wound. An overproduction of collagen is thought to cause keloids to start growing.

If you have had a keloid scar before, you're more likely to get another. In people with keloid-prone skin, extra tissue grows and forms a smooth, hard, raised growth. A keloid may not develop for weeks or months after the injury, or it can grow quickly after the injury. The underlying cause why some people’s skin is prone to keloids is not known. 

Keloids can develop after:

  • A cut, puncture wound, scratch, or surgical incision
  • A burn
  • Tattoo or piercing
  • Chickenpox sores heal
  • Serious acne
  • An insect bite
  • Needle injection
  • Consistently wearing tightly braided hair
  • Shaving their face, keloids can develop in men’s beard area
  • No injury to the skin, called a spontaneous keloid

Who’s at risk for keloids?

About 10% of the world’s population have keloid scars. People with these characteristics are more likely to develop a keloid after an injury:

  • African, Asian, or Hispanic descent
  • Darker skin
  • Family history of developing keloids
  • Between 10 to 30 years of age, although it can develop earlier or later; children and elderly people almost never develop a keloid after an injury
  • History of having had keloids
  • Pregnant women of all skin types

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Symptoms

What do keloids look like?

Keloids can be flesh-colored, pink, red or purple, changing to brown or pale after they stop growing. Keloids are usually darker than the surrounding skin, and have a border that’s darker than the center of the keloid. 

The skin’s surface can be lumpy or form a ridge over the scar. It may feel soft like dough, or it may feel like hard rubber. They are usually shiny and hairless. When you touch the keloid it does not feel like your normal skin. 

The keloid keeps growing as scar tissue continues to form. Skin can be itchy, but rarely painful. After the keloid stops growing, most of the itching or tenderness disappear. Depending on their location, keloids can be uncomfortable, tender or be irritated because of clothing rubbing against them. 

The size and shape vary. For example, a pierced earlobe may develop a round, solid mass. A chest or shoulder area injury may cause the keloid to spread out. Their size ranges from smaller than an inch to larger than a football. If it forms over a joint or a large area of skin, it can make it hard to move that part of the body. Most keloids don’t move when you touch them. However, an earlobe keloid may dangle from a piece of skin. Keloids can develop anywhere on the body, but are more common on the ears, neck, chest, shoulders and back.

Diagnosis

How are keloids diagnosed?

They are not difficult to diagnose and a dermatologist can tell if it’s a keloid by looking at it. If it resembles other types of skin growth, he or she may take a skin biopsy to confirm the diagnosis.

Treatment

How are keloids treated?

Your dermatologist may recommend several types of treatment because keloids can be hard to remove, and some return after treatment. There is no treatment that works for every keloid. Using two or more types of treatment can give you the best outcome. If you’ve ever had a keloid before, be sure to tell your dermatologist. 

 A treatment plan may include one or more of these options. Having at least three treatment methods seems to provide the best result.

  • Corticosteroids and other medications are injected into the keloid to help shrink it. Most patients need a series of shots, every three to four weeks, for about four months. The first shots relieve symptoms and soften the keloid. This treatment works for 50% to 80% of patients, but most will return within five years. Additional treatments will be used to prevent the regrowth.
  • Surgery can remove the keloid, but almost all surgical removals result in the keloid returning. Other treatments are required to prevent the regrowth.
  • Cryotherapy helps reduce the risk of regrowth, and may be used along with corticosteroid injections. Cryotherapy “freezes” the tissue from the inside and preserves the skin under the keloid. It works best on small keloids and can reduce the size and hardness of a keloid. At least three treatments are needed.
  • Radiation treatments are often used immediately after surgery to prevent regrowth.
  • Pressure, in the form of a special earring (to prevent earlobe keloids), a dressing or a garment are often used after surgery. Putting pressure on the site of the keloid will reduce blood circulation and stop keloids from returning. Patients wear the pressure device for about 16 hours a day for six months to a year. This method is 90% to 100% effective after surgery.
  • Silicone sheets and gels can be used with the pressure method to prevent regrowth. Silicone sheets can also be used alone to flatten keloids. This is successful in about a third of cases.
  • Laser treatments are used to fade the color of keloids and reduce the raised part, making it more level with surrounding skin. Lasers are often used with pressure and corticosteroid shots. 
  • Ligature is a surgical thread tied around the keloid. It gradually cuts into the keloid and it eventually falls off. The thread has to be replaced every two to three weeks.

References

American Academy of Dermatology Association. (N.d.) What is a keloid? Retrieved 9-21-21, ({https://www.aad.org/public/diseases/a-z/keloids-overview}
American Academy of Dermatology Association. (N.d.) Keloid: Signs and Symptoms. Retrieved 9-21-21, {https://www.aad.org/public/diseases/a-z/keloids-symptoms}
American Academy of Dermatology Association. (N.d.) Keloid: Who Gets and Causes. Retrieved 9-21-21, {https://www.aad.org/public/diseases/a-z/keloids-causes}
American Academy of Dermatology Association. (N.d.) Keloids: Diagnosis and Treatment. Retrieved 9-21-21, {https://www.aad.org/public/diseases/a-z/keloids-treatment}
American Academy of Dermatology Association. (N.d.) Keloids: How to Prevent These Raised Scars. Retrieved 9-21-21, {https://www.aad.org/public/diseases/a-z/keloids-self-care}
National Health Service. (June 2019). Keloid Scars. Retrieved 9-21-21. {https://www.nhs.uk/live-well/healthy-body/keloid-scars/}
Healthline. (June 2019). Everything You Need to Know About Keloid Scars. Retrieved 9-21-21, {https://www.healthline.com/health/keloids}

Information

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

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Initial Visit

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Follow Up