Keloid (Abnormal Scars) by David Robles, MD, PhD

What is a Keloid?

A keloid is abnormally thickened scar. They are firm nodules, which can be skin colored, or reddish in color. Keloids are frequently symptomatic, with most patients reporting tenderness or itchiness. 

How Do You Get Keloids?

Keloids develop following injury or inflammation of the skin. Genetic factors may be involved since they sometimes run in families. They occur more frequently among Blacks, Hispanics and Asians and less commonly in Caucasians. 

Keloids may occur after surgery or from non-surgical injury (e.g., lacerations and earlobe piercing). 

Inflammatory skin conditions such as acne and folliculitis may also induce keloid formation. Keloids can develop months after a wound or inflammatory process, but may develop even a year later. Keloids occur most commonly on the chest, shoulders, upper back, back of the neck and earlobes.

How are Keloids Treated?

Corticosteroid injections (steroid injection for short) is the most commonly used form of treatment. Multiple injections at regular monthly intervals are generally required for larger keloids. Steroid injections help soften and reduce the symptoms of itchiness and tenderness.

Surgical excision may be gratifying, providing an immediate cosmetic correction, but there is always a concern for recurrence. Post-excisional steroid injections should be considered.

Radiation treatment following surgical excision has also been reported with benefit. Certain lasers may be helpful as well. Silicone gel dressings are a non-invasive and relatively inexpensive adjunctive treatment modality for keloids.

 

Prevention

Patients with a previous keloid or a family history of keloids are at increased risk for developing abnormal scars. These patients should be counseled against body piercing and should avoid elective cosmetic procedures with a risk for scarring.