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Keloids

  • Overgrowths of scar tissue that can sometimes appear when an injury heals
  • Typically develop on the torso and sometimes on the face or earlobes
  • Treatments include steroids, cryotherapy, and surgical excision
  • Involves Dermatology, Dermatologic Surgery, Plastic & Reconstructive Surgery

Overview

We’re familiar with the way our skin heals after a minor burn or injury. A thin, smooth crust forms over the damaged layer of skin before falling off to reveal a pink-ish layer, which is the scar. But sometimes, for reasons that are still not completely known, your skin can overreact to the damage with an overgrowth of scar tissue that rarely goes away on its own. These overgrowths, called keloids, are generally shiny, firm and smooth, just like regular scars, but often cover a much larger area and continue to grow for weeks or months after the injury. They typically develop on the torso and sometimes on the face and earlobes.

Although anyone can get them, keloids are more common among darker-skinned people.

Keloids can be painful or itchy but aren’t usually dangerous to a person’s health. However, depending on where they are located, they can be a cosmetic concern. Fortunately, there are many treatment options to help remove keloids.

“Keloids can be very challenging to treat, but doctors can work with you to figure out a solution that works best for your circumstances and goals,” says Henry Hsia, MD, a plastic surgeon at Yale Medicine. 

What causes keloids?

It is still unclear why some people are more likely to develop keloids rather than regular scars, but it seems that the longer a wound takes to heal, the greater the risk a person has of developing an overgrowth of scar tissue. Other things that may increase your risk include the following:

  • A family history of keloids
  • Mesh skin grafts (a procedure that involves enlarging donor skin to cover a large open wound)
  • Puberty or pregnancy (the elevated level hormones may affect the wound healing process) 

How are keloids diagnosed?

Keloids are usually diagnosed through a clinical exam with your doctor, who is usually able to make a diagnosis by looking at the scar shape, size, and growth pattern, and by taking a patient’s medical history. Sometimes, your doctor may conduct tests to make sure that your scar growths are not a sign of such rare but more serious conditions as nodular scleroderma, giant cell fibroblastoma, and lobomycosis.

How are keloids treated?

Prevention is often more effective than treatment, as removing a keloid often causes another skin wound, leading to potentially developing another keloid. “Since we don’t understand keloids themselves, treatment can possibly stimulate more keloid formation,” says Dr. Hsia. “It’s something about the way the body responds to trauma. A scar that looks like it was well-healed can turn into a keloid. Generally speaking, they don’t go away. No matter what we do, it carries a risk of making the keloid worse.”

The following might be used to prevent keloids during the wound healing process:

  • Silicone sheet or gel : This may be applied to increase hydration to the wound and decreasing risk of keloids. 
  • Compression therapy : A therapy that uses tight clothing to create pressure and, thus, decrease collagen and blood flow, which may decrease the development of scar tissue.

Once the keloid has formed, your doctor may use the following treatment options:

  • Intralesional corticosteroids : These are injected to soften and flatten the scar by reducing collagen. They can reduce inflammation and constrict blood vessels.
  • Intralesional fluorouracil : For patients who do not respond to intralesional corticosteroids, this chemotherapy medication, usually used to treat cancer, is injected into the scar tissue
  • Cryotherapy: This is a fairly effective therapy for keloids in which scar tissue is destroyed by freezing.
  • Surgical excision: This technique uses surgery to remove the scar tissue. However, because it creates a significant amount of trauma to the skin, surgery may make it more likely that the keloids will return.
  • Radiation therapy: Studies show that low-dose radiation therapy, used in conjunction with other therapies, may be effective in reducing recurrence of keloids 
  • Laser therapy : This is a fairly new form of therapy used for keloids that uses light rays to destroy scar tissue.