Keloid scar

Overview

A keloid scar is a thick raised scar. It can occur wherever you have a skin injury but usually forms on earlobes, shoulders, cheeks or the chest. If you're prone to developing keloids, you might get them in more than one place.

A keloid scar isn't harmful to your physical health, but it can cause emotional distress. Prevention or early treatment is key.

Keloid scar treatment is possible. If you don't like how a keloid looks or feels, talk with a doctor about how to flatten or remove it. Even with treatment, a keloid can last for years or recur.

Symptoms

A keloid scar may form within months to years of the inciting injury. Signs and symptoms might include:

• Thick, irregular scarring, typically on the earlobes, shoulders, cheeks or middle chest
• Shiny, hairless, lumpy, raised skin
• Varied size, depending on the size of the original injury and when the keloid stops growing
• Varied texture, from soft to firm and rubbery
• Reddish, brown or purplish, depending on your skin color
• Itchiness
• Discomfort

When to see a doctor

Early treatment can help minimize growth of a keloid. Talk with a doctor soon after you notice a keloid. If you want to treat one that you've had for a while, talk with a doctor who specializes in skin conditions (dermatologist).

Causes

Experts don't completely understand what causes keloid scars. But most agree it's likely a dysfunction of the wound-healing process. Collagen — a protein found throughout the body — is useful to wound healing, but when the body produces too much, keloids can form.

Keloid growth might be triggered by any sort of skin injury — an insect bite, acne, an injection, body piercing, burns, hair removal, and even minor scratches and bumps. Sometimes keloids form for no obvious reason.

Keloids aren't contagious or cancerous.

A keloid is different from a hypertrophic scar. A hypertrophic scar stays within the bounds of the original wound and can fade over time without treatment.

Risk factors

Risk factors for keloids include:

• Having brown or Black skin. Keloids are most common in people with brown or Black skin. The reason for this predisposition is unknown.
• Having a personal or family history of keloids. Keloids can run in families, indicating that the tendency might be inherited. If you've had one keloid, you're at risk of developing others.
• Being under 30. You're more likely to develop a keloid if you're between the ages of 20 and 30.

Complications

Keloids located on a joint might develop hard, tight tissue that restricts movement.

Prevention

If you're prone to developing keloids, take these preventive self-care tips:

• Practice good wound care. Keep a wound clean and moist. Gently wash the area with mild soap and water. Apply a thin layer of petrolatum jelly (Vaseline, Aquaphor) or other ointment. Reapply the ointment throughout the day as needed. Your doctor might recommend applying a pressure pad or a silicone gel pad to a wound while it's healing. Adults need to take these preventive steps for six months after skin injury, and children up to 18 months.

  Applying pressure earrings to your earlobes after an ear piercing helps prevent keloids.

• Protect your skin from injury. Try to avoid injuring your skin. Consider not getting body piercings, tattoos and elective surgeries. Even minor injuries — such as ingrown hairs, cuts and scratches — can incite a keloid to grow.

  If you decide to undergo surgery, talk with your doctor about your tendency to develop keloids. Your doctor can use surgical techniques that reduce the risk of developing keloids at the surgical site. After surgery, ask your doctor about postoperative care and follow the instructions carefully.

Diagnosis

Your doctor usually can tell whether you have a keloid by looking at the affected skin. You might need a skin biopsy to rule out skin cancer.

Treatment

Keloid scar treatments include the following. One or a combination of approaches might be best for your situation. Even after successful flattening or removal, keloids can grow back, sometimes bigger than before. Or you may develop new ones.

• Wound care. For newer keloids, the first treatment option might be compression dressings made from stretchy fabric or other materials. This method is also used after surgery to remove keloids. The goal is to reduce or prevent a scar by putting pressure on the wound as it heals. Such dressings need to be worn for 12 to 24 hours a day for 4 to 6 months to be effective. This method can be very uncomfortable.
• Corticosteroid cream. Applying a prescription strength corticosteroid cream can help ease itchiness.
• Injected medicine. If you have a smaller keloid, your doctor might try reducing its thickness by injecting it with cortisone or other steroids. You'll likely need monthly injections for up to six months before seeing the scar flatten. Possible side effects of corticosteroid injections are skin thinning, spider veins and a permanent change in skin color (hypopigmentation or hyperpigmentation).
• Freezing the scar. Small keloids might be reduced or removed by freezing them with liquid nitrogen (cryotherapy). Repeat treatments might be needed. Possible side effects of cryotherapy are blistering, pain and loss of skin color (hypopigmentation).
• Laser treatment. Larger keloids can be flattened by pulsed-dye laser sessions. This method has also been useful in easing itchiness and causing keloids to fade. Pulsed-dye laser therapy is delivered over several sessions with 4 to 8 weeks between sessions. Your doctor might recommend combining laser therapy with cortisone injections. Possible side effects, which are more common in people with darker skin, include hypopigmentation or hyperpigmentation, blistering and crusting.
• Radiation therapy. Low-level X-ray radiation alone or after surgical removal of a keloid can help shrink or minimize the scar tissue. Repeat treatments might be needed. Possible side effects of radiation therapy are skin complications and, in the long term, cancer.
• Surgical removal. If your keloid hasn't responded to other therapies, your doctor might recommend removing it with surgery in combination with other methods. Surgery alone has a recurrence rate of 45% to 100%.

Alternative medicine

There are no proven methods of removing keloid scars naturally. Some clinical studies have shown that onion extract used orally or on the skin might possibly be effective in improving the appearance of keloid scars and reducing itchiness and discomfort.

Potential future treatments

Research into wound-healing issues, including keloid formation, shows promise. For example, studies include:

• Experimental topical creams and injectables to reduce and stop the growth of keloids
• Botulinum toxin type A (Botox) to improve wound healing
• Identifying genetic markers in keloid tissue
• Stem cell therapy

Lifestyle and home remedies

Try these keloid self-care tips:

• Care for your wound as directed. Wound care can be time-consuming, and compression dressings can be uncomfortable. Try to stick with the routine recommended by your doctor, as these steps are important to keloid prevention.
• Apply a corticosteroid cream. This type of nonprescription cream can help ease itchiness.
• Apply silicone gel. Applying nonprescription silicone gel can help ease itchiness.
• Protect the area from re-injury. Avoid irritating the keloid with clothing or other types of friction or injury.
• Protect your skin from the sun. Sun exposure might change the color of your keloid, making it more noticeable. That change might be permanent. Before going outside, protect your skin by covering the keloid or by liberally applying sunscreen.

Preparing for an appointment

Call your doctor if you notice a change in your skin that might indicate a keloid is forming or if you've been living with a keloid for a while and want to seek treatment. After your initial appointment, your doctor may refer you to a doctor who specializes in the diagnosis and treatment of skin conditions (dermatologist).

You might want to ask a trusted family member or friend to come to your appointment, if possible. Someone close to you may provide additional insight about your condition and can help you remember what's discussed during your appointment.

What you can do

Before your appointment, make a list of:

• Any symptoms you've been experiencing, and for how long
• Your medical information, including other injuries or surgeries you've had and whether your family has a history of keloids
• Questions to ask your doctor to make the most of your time together

Questions may include:

• Am I at risk of developing keloids?
• How can I reduce the risk of developing a keloid?
• What if I want to get a tattoo or body piercing?
• What if I need surgery?
• How soon after beginning treatment might my symptoms start to improve?
• When will you see me again to evaluate whether my treatment is working?
• What are the chances of the keloid coming back?
• What are possible side effects of the treatment you're suggesting?
• I'm scheduled for surgery. What can I do to minimize the risk of a keloid developing from the scar?
• What's your advice on wound care after surgery?
• Can my keloid turn into cancer?
• What self-care steps might prevent a keloid from coming back?
• Do you recommend any changes to the products I'm using on my skin, including soaps, lotions, sunscreens and cosmetics?

Don't hesitate to ask any other questions.

What to expect from your doctor

Your doctor or mental health provider may ask:

• When did you first develop this problem?
• Have your symptoms been getting better or worse over time?
• Have any of your relatives had similar symptoms?
• How is your skin condition affecting your self-esteem and your confidence in social situations?
• What treatments and self-care steps have you tried so far? Have any been effective?
• Have you ever been injured?
• Have you ever had surgery?