Keloid

(Keloid Scar; Dermal Fibrotic Lesion)
  • Definition

    A keloid is an extra growth of scar tissue over a skin wound. It grows beyond the margins of the skin wound. A keloid can vary in size from one to several inches. They are not harmful to general health.
    Keloids can occur anywhere but they are more common on:
    • Earlobes
    • Shoulders
    • Upper back
    • Chest
    • Back of scalp and neck
  • Causes

    Scar tissue is a part of the normal healing process. With keloids, the scar tissue grows in an uncontrolled manner. The scar continues to grow even after the wound has been covered. The growth can continue for weeks or months.
  • Risk Factors

    Keloids are more common in people with African American, Asian, or Hispanic ethnicity. They are also more likely to occur between 10-30 years old.
    Factors that increase your chance of keloids include:
    • Deep skin wounds, such as those from infections, 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.
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  • Symptoms

    Keloids often begin as small lumps at the site of a skin injury. They gradually grow beyond the edges of the wound.
    For most, the scar is the only symptom. Some may have other symptoms such as:
    • 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 skin specialist. They can confirm the diagnosis and assist in removal. A plastic surgeon may do the removal.
    Your doctor may order a biopsy. This test will rule out other problems like a tumor or other skin disorders.
  • Treatment

    Some keloids may go away on their own, but this is rare. If the keloid is not bothersome, then it does not need to be treated.
    A large or irritating keloid may be removed with surgery. Most keloids will grow again after surgery. Other treatments may help to prevent recurrence. Prevention treatment options include:
    Corticosteroid Injections
    These injections are often given with surgery. They are repeated every 3-4 weeks for six months. Steroids can relieve itching and pain and slow the scar formation. For some, it may cause some shrinking of the keloid.
    Radiation Therapy
    Your doctor may recommend radiation after surgery. This therapy can be successful at stopping regrowth. However, it is a limited option because it is toxic to healthy tissue.
    Other Medications
    Other medications that may also help prevent regrowth of a keloid after surgery include:
    • Verapamil—injected directly into area
    • Fluorouracil—injected directly into area
    • Imiquimod—cream applied to the affected area
  • Prevention

    To help reduce your chances of forming a keloid, take the following steps:
    • Avoid trauma to the skin.
    • Care for cuts or scrapes right away.
    • Avoid unnecessary cosmetic surgery.
    • Do not tattoo or pierce your ears or other areas of the body.
  • RESOURCES

    American Academy of Dermatology http://www.aad.org

    American Society of Plastic Surgeons http://www.plasticsurgery.org

    CANADIAN RESOURCES

    Canadian Dermatology Association http://www.dermatology.ca

    Health Canada www.hc-sc.gc.ca

    References

    Scar revision. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/Reconstructive-Procedures/Scar-Revision.html. Accessed August 5, 2013.

    Conejo-Mir JS, Corbi R, et al. Carbon dioxide laser ablation associated with interferon alfa-2b injections reduces the recurrence of keloids. J Am Acad Dermatol.1998; 39:1039.

    Keloid. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated July 18, 2013. Accessed August 5, 2013.

    Malaker K, Vijayraghavan K, et al. Retrospective analysis of treatment of unresectable keloids with primary radiation over 25 years. Clin Oncol. 2004;16:290.

    Shaffer JJ, Taylor SC, et al. Keloidal scars: A review with a critical look at therapeutic options. J Am Acad Dermatol. 2002; 46:S63.

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