What are Keloids?
A keloid is a type of scar which is an excessive production of scar tissue made from collagen which can become larger than the original wound and extend beyond the edges of the original scar or area of trauma. They are more common in darker skin types and on the upper part of the body, most commonly on the breastbone, shoulder, earlobe and cheek. While surgical scars or wounds can become a little raised or hypertrophic, a keloid is different as it may become a greatly exaggerated wound healing response even to minimal trauma, such as a piercing.
What causes Keloids?
We don’t fully understand what causes keloids. Keloids can occur after a very minor skin injury even if there has been no noticeable damage to the skin. They can result from acne scarring, a surgical scar, wounds under tension while healing or wounds that get infected, burns, or from ear or body piercing or any inflammatory lesion (such as chicken pox). Most people will only have one or two keloid scars but some people can have many as a result of acne scars or chicken pox scars. Keloids are not contagious and there are no other medical complications associated with them.
Who is at risk of Keloids?
Keloids are common in darker skin types and especially common in people with black skin. Keloids are most common in patients between the ages 10 and 30 years. Patients are more at risk of developing a keloid if they have a past history of keloids, are a darker skin type, or have family members with keloids.
What are the symptoms of Keloids?
Keloids typically develop from three months to a year after the original skin damage, but can occur at any time after the event. A rubbery scar tissue starts growing beyond the borders of the original damage. The keloid scar is raised above the surrounding skin and they are sometimes domed in appearance. Keloids are shiny and hairless and may become very hard, tender, itchy, and painful or produce a burning sensation. The original red colour changes to brown or becomes pale and if they are positioned near a joint can limit movement of the joint. They can also be quite disfiguring especially if they occur on the scalp, face or neck.
How do Dermatologists diagnose keloids?
A Dermatologist will diagnose a keloid by visual examination. It is not normally necessary to perform any diagnostic tests and in fact a biopsy would be counter-productive as it causes further trauma and may exacerbate the keloid.
How does a Dermatologist treat Keloids?
It is difficult to permanently treat keloids, as cutting out a keloid can result in a larger scar and therefore a larger keloid forming. The aim of treatment is usually to flatten the scar or alleviate symptoms of itch or pain rather than to completely eradicate it.
Topical treatment such as a super-potent topical steroids or a steroid-impregnated tape or plaster to apply to the keloid. Response to treatment is slow and gradual. More effective treatment is to inject the keloid with intralesional steroid, but this usually needs to be repeated, especially with larger and harder keloids, and is usually done every four to eight weeks. Accelerated results can sometimes be achieved with the mixing low concentrations of fluorouracil, a chemotherapeutic agent, with the steroid in the intralesional steroid injections.
Laser treatment or intense pulsed light therapy are sometimes used in conjunction with steroid injections or topical treatment as a way of reducing the colour and pigmentation in the scar, however laser treatment by itself will usually not flatten the scar. In special circumstances such as very large scars a keloid scar may be excised (cut out) but strict follow-up is required with intralesional triamcinolone injections used in the perioperative period. There is always a risk the keloid scar occurring.
Radiotherapy has also been used in the past for keloids however this type of treatment is now not considered warranted for a benign condition as there will be long-term atrophic changes to the skin.
No treatment for keloid scars is guaranteed and the keloid may reoccur at the same site shortly after the treatment has finished or even at a much later stage.
People who are at risk of keloid scars should avoid tattoos and body piercing as both these procedures can cause keloid scarring. Ear piercing has resulted in keloids the size of golf balls developing on the lobe. If you are at risk of keloid scarring and suffering from acne it is important to seek medical advice from a Dermatologist to quickly control the acne to minimise the risk of keloid scarring.
Keloids can be large and disfiguring and can cause anxiety and distress. Camouflage make-up can help with disguising the lesion and building self-esteem.
If you think you have a keloid scar and you would like an opinion on the treatment options and the expected outcome from treating the keloid scar then book a dermatology consultation with one of our Dermatologists by calling 020 7183 4565 or emailing the clinic at doctor@LSAH.co.uk.