Keloids are dense, fibrous tissue nodules typically found at areas of previously traumatized skin (eg, burns, lacerations, incision scars), or arising spontaneously on normal skin. Lesions may be single or multiple. Over weeks to months, these large nodules can become painful, tender, pruritic, and grow to become very large (up to 30 cm). They can cause chronic discomfort, be disfiguring, and restrict normal tissue motion. Most patients start developing keloids in their 20s.
Keloids can affect individuals of any race and ethnicity. There is likely a genetic basis for the tendency to develop keloids, and research is ongoing.
A distinction should be made between a keloid and a hypertrophic scar. All trauma that involves the dermis will heal with a scar; however, in certain individuals, the scar is much larger and thicker than what is considered normal. These lesions are termed hypertrophic scars. In contrast to keloids, hypertrophic scars are always preceded by trauma and are always confined to the margin of the wound. Hypertrophic scars also appear immediately after trauma and show a tendency to gradually regress, whereas keloids can be delayed in appearance and are thought to very rarely spontaneously resolve.
Keloids are dense, thick nodules (solid, raised bumps that are firm to the touch) or plaques (raised or bumpy areas larger than a thumbnail) typically found at areas of previously injured skin (such as burns, cuts, and piercings), or they may arise spontaneously on healthy skin. Over weeks to months, keloids can become painful and itchy, and they may grow to become very large, up to about 30 cm. They can be disfiguring, and individuals with keloids often seek removal.
Who’s At Risk
Keloids affect people of all ages, but most people start developing keloids in their 20s. Keloids can appear in people of any race / ethnicity. The areas of the skin that are prone to keloid formation include the neck, ear lobes, legs, arms, and upper trunk. If you have a keloid, you are at risk of more keloids forming in these areas whenever the skin is injured.
Signs & Symptoms
Keloids are usually seen on the neck, ear lobes, legs, arms, and on the upper trunk, especially the chest. They frequently appear in the site of a previous injury. Keloids that arise spontaneously are common on the middle of the chest. Keloids are smooth, shiny, firm to the touch, and may have regular or irregular ridges. In lighter skin colors, they are often skin-colored, pink, or reddish. In darker skin colors, they are skin-colored or any shade of brown. Keloids may grow larger than the original area of injury.
Avoid unnecessary skin injury, such as getting piercings. Some keloids respond to silicone sheeting (eg, Nuvadermis Scar Sheets) applied to the skin on an ongoing basis for months. The sheeting may soften and flatten the keloid somewhat, although usually not completely.
When to Seek Medical Care
Seek medical evaluation if keloids become bothersome or cause pain or itch.
Keloids are difficult to treat, but your medical professional may try the following:
Silicone gel sheeting, if not previously used.
There has been some success in treating small earlobe keloids with pressure or "clip-on" earrings.
Keloids often respond to steroid injections, such as triamcinolone acetonide (Kenalog), into the keloid. There is a risk of skin lightening (hypopigmentation) with steroid injections.
Alternative therapies include:
Freezing (cryosurgery) plus steroid injections.
Surgery followed by steroid injections to the affected area. Note; however, that surgical removal of keloids may lead to the keloid coming back (recurring) larger than it was before the excision, and repeated steroid injections may be needed to prevent this complication.
Laser therapy with a pulsed-dye laser for lesions that are actively growing / enlarging.