Keloids are raised overgrowths of scar tissue that develop at the site of skin injury. They can occur where trauma, surgery, blisters, vaccinations, acne, or body piercings have damaged the skin. Occasionally, keloids may form in areas without a visible injury. These differ from normal scars in both their composition and size. Some individuals are genetically predisposed to keloid formation and may develop them in multiple locations.
Who Is Affected by Keloids?
Keloids are more common in African-Americans and can appear on various parts of the body, including the shoulders, upper back, and chest, although they can develop anywhere. When keloids are associated with an incision or injury, the scar tissue continues to grow even after the wound has closed, becoming larger and more visible until it reaches a final size. Keloids typically occur between the ages of 10 and 30 and affect both sexes equally. However, they may be more common among young women with pierced ears. Additionally, keloids may form over the breastbone in individuals who have undergone open-heart surgery.
Symptoms of Keloids
Keloids usually manifest in areas of previous trauma but may extend beyond the injured site. They are characterized by shiny, smooth, and rounded skin elevations that can be pink, purple, or brown. Keloids may have a doughy or firm rubbery texture and often feel itchy, tender, or uncomfortable. They can be cosmetically displeasing and, in severe cases, a large keloid over a joint can interfere with joint function.
Diagnosing Keloids
A doctor diagnoses keloids based on their appearance and the patient’s history of tissue injury, such as surgery, acne, or body piercing. In rare instances, the doctor may perform a biopsy, which involves removing a small piece of skin to examine under a microscope, to confirm the diagnosis.
Duration of Keloids
Keloids can continue to grow slowly over weeks, months, or even years, but they eventually stop growing. Once a keloid develops, it is permanent unless treated or removed. However, it is common for keloids to recur after treatment.
Preventing Keloids
Individuals prone to keloids should avoid unnecessary cosmetic surgery. When surgery is essential, doctors can take specific precautions to minimize keloid formation at the incision site. Techniques to reduce the likelihood of keloid formation include covering the healing wound with hypoallergenic paper tape for several weeks post-surgery, using small sheets made of silicone gel, or applying a topical corticosteroid at the surgical wound site during the initial healing period.
Treating Keloids
There is no single treatment for keloids, and most treatments do not yield entirely satisfactory results. Often, a combination of treatments is employed. It is advisable to start treatment soon after a keloid appears for the best outcomes. Treatment options include:
- Surgical Removal: This method involves cutting out the keloid, but it requires careful execution as keloids can recur, often larger than the original. The recurrence rate is over 45% when keloids are removed surgically. Combining surgical removal with other treatments can reduce the likelihood of recurrence.
- Dressings: Moist wound coverings made of silicone gel sheets have been shown to reduce the size of keloids over time. This treatment is safe and painless.
- Corticosteroid Injections: Injecting corticosteroids, such as triamcinolone acetonide, directly into keloids at intervals of four to six weeks can often reduce their size and irritation. However, the injections can be uncomfortable.
- Compression: Applying continuous pressure to the keloid using a bandage or tape for six to twelve months can reduce its size. For keloids at ear piercing sites, a “Zimmer splint,” which resembles an earring, can reduce the keloid size by at least 50% after one year of compression.
- Laser Therapy: This is an alternative to conventional surgery, but there is no substantial evidence suggesting keloids are less likely to return after laser therapy compared to regular surgery.
- Fluorouracil Injections: For keloids resistant to other treatments, injections of the chemotherapy drug fluorouracil combined with triamcinolone may be used.
When to Consult a Professional
Keloids primarily pose cosmetic concerns. If a scar becomes enlarged, itchy, uncomfortable, interferes with joint movement, or creates an unacceptable cosmetic effect, consult your doctor to discuss treatment options.
Prognosis of Keloids
Keloids are benign and do not become malignant. Once a keloid stops growing, it usually remains stable unless the area is injured again. Despite being harmless, the cosmetic impact and potential discomfort can necessitate medical intervention for many individuals.
In conclusion, while keloids are not harmful, they can be a significant cosmetic concern and cause discomfort. Understanding the causes, recognizing the symptoms, and exploring the various treatment options with a healthcare professional can help manage and potentially reduce the impact of keloids on affected individuals. Preventive measures and early treatment are crucial in minimizing the recurrence and progression of these persistent scars.
