Keloids

  • Overview

    Keloids: Overview

    What is a keloid?

    keloids-on-chest.jpg
    Chest scars: A raised scar (A) rises above the skin; whereas, a keloid (B) rises above the skin and spreads.

    A keloid (key-loid) is a type of raised scar. Unlike other raised scars, keloids grow much larger than the wound that caused the scar.

    Not everyone who gets a scar will develop a keloid. If you have keloid-prone skin, however, anything that can cause a scar may lead to a keloid. This includes a cut, burn, or severe acne. Some people see a keloid after they pierce their ears or get a tattoo. A keloid can also form as chickenpox clear. Sometimes, a surgical scar becomes a keloid.

    In very rare cases, keloids form when people do not injure their skin. These are called “spontaneous keloids.”

    A keloid usually takes time to appear. After an injury, months can pass before this scar appears. A keloid can also form more quickly.

    Once it begins, a keloid can enlarge slowly for months or years.

    Keloids do not turn into cancer.

    The size and shape of keloids vary. On an earlobe, you’ll likely see a round, solid mass. When a keloid forms on a shoulder or the chest, the raised scar tends to spread out across the skin. It often looks like a liquid spilled on the skin and then hardened.

    As these raised scars grow, they may feel painful or itchy. A keloid that covers a joint or large area can decrease a person’s ability to move that part of the body.

    Treatment can help reduce symptoms like pain and itch. If the scar makes moving difficult, treatment can help a person regain some movement.

    Treating a keloid, however, can be involved. To reduce the chance of another keloid forming after treatment, more than one type of treatment may be necessary.

    No one treatment is best for all keloids. To give their patients the best results, dermatologists choose treatment based on the patient’s age, type of keloid, and other considerations. For example, one patient with a keloid on an earlobe may get better results if the scar is surgically removed in layers (called shaving) than surgically cut out.

    Because keloids can be a challenge to treat, dermatologists recommend taking steps to prevent keloids. You’ll find tips for preventing these scars along with information about treatment and who gets these scars by clicking on tabs above.

    Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.


    References
    Burton CS and Escaravage V. “Hypertrophic scars and keloids.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1487-1502.

    Daggett A, Congcharoen J, et al. “Top 10 things you need to know about keloids and their treatment.” J Miss State Med Assoc. 2016;57(4):108-11.

    Kelly AP. “Keloids” In Kelly AP, Taylor SC, et al. Dermatology for Skin of Color. The McGraw Hill Companies, China, 2009. 178-94.


    Keloids
    Save
  • Symptoms

    Keloids: Signs and symptoms

    keloid-earlobe.jpg
    Keloid on a girl’s earlobe: After getting her ears pierced, this raised scar slowly developed.

    What you see on the skin

    If you develop a keloid, you’ll likely notice one or more of the following signs and symptoms. Keloids tend to:

    • Appear slowly: It can take 3 to 12 months or longer to see the first signs of a keloid. Most appear within a year of whatever caused the skin to scar.

    • Begin as a raised pink, red, or purple scar. If the keloid appears on the earlobe, it’s likely to be round or oval. On the chest, legs, or arms, a keloid is likely to be a raised scar with a flat surface.

    • Grow slowly: Once you see a keloid, it tends to grow slowly. Most continue to spread for weeks or months. At times, a keloid can grow for years.

      A keloid can also grow quickly. Some triple in size within a few months.

    • Feel soft and doughy or hard and rubbery: When you touch the scar, it will feel different from your surrounding skin. On the earlobe, it’s most likely to feel firm.

    • Cause pain, itch, or tenderness: While a keloid is growing, it can feel itchy, painful, or both. Keloids on the chest are often tender. Once a keloid stops growing, symptoms usually stop.

    • Be fixed in place: Most keloids are solid and won’t move. On the neck, abdomen, or an ear, a keloid may hang by a stalk, so it moves slightly when you touch it.

    • Become darker in color with time: Once a keloid stops growing, it tends to be darker than the person’s skin. The border is usually darker than the center.

    keloids-acne-chest.jpg
    Keloids on a man’s chest: These keloids appeared slowly after severe acne cleared.

    Where keloids appear

    These scars appear from the head to the feet. Keloids, however, are most likely to develop on the following areas of the body:

    • Ears
    • Neck
    • Shoulders
    • Chest
    • Back

    It’s rare for a keloid to form on an eyelid, genital, palm, or sole.

    Size of keloids

    keloids-chickenpox.jpg
    2 keloids on girl’s jawline: These keloids formed where she once had chickenpox.

    These raised scars range in size from smaller than an inch to larger than a football. The largest keloids tend to form on the shoulders and back.

    Can take an emotional toll

    Keloids can be hard on a person’s self-esteem. These scars can be noticeable. Large ones can limit how much a person can move that area of the body.

    Most people who seek treatment for a keloid do so because they dislike how it looks.

    Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.


    References
    Burton CS and Escaravage V. “Hypertrophic scars and keloids.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1498.

    Daggett A, Congcharoen J, et al. “Top 10 things you need to know about keloids and their treatment.” J Miss State Med Assoc. 2016;57(4):108-11.

    Kelly AP. “Keloids” In Kelly AP, Taylor SC, et al. Dermatology for Skin of Color. The McGraw Hill Companies, China, 2009. 178-94.

    Monstrey S, Middelkoop E, et al. “Updated scar management practical guidelines: Non-invasive and invasive measures.” J Plast Reconstr Aesthet Surg. 2014 Aug;67(8):1017-25.


    Keloids
    Save
  • Causes

    Keloids: Who gets and causes

    keloids-causes.jpg
    Some people are more likely to get keloids: Young adults who have dark skin are more likely to develop a keloid.

    Who gets keloids?

    Men and women worldwide develop these raised scars. Some people, however, have a higher risk of developing a keloid when they scar. You’re more likely to develop a keloid if you have one or more of the following:

    • African, Asian, or Hispanic descent. The keloid is the most common skin condition among ethnic Chinese in Asia. In the United States, keloids are more common in African Americans and Hispanic Americans than whites.

    • Family history of keloids. About 1/3 of people who get keloids have a first-degree blood relative (mother, father, sister, brother, or child) who gets keloids. This family trait is most common in people of African or Asian descent.

    • Between 10 and 30 years of age. This is the peak time to develop keloids. Most people begin seeing keloids in their 20s. Although keloids can develop earlier or later, children and the elderly rarely get a keloid when they scar.

    What causes keloids?

    Most people get these scars after they injure their skin, such as from a cut or puncture wound. Getting a tattoo or piercing can also cause a keloid.

    Sometimes, a surgical scar turns into a keloid. Some women who have had a cesarean section (C-section) or hysterectomy get keloids after the surgery.

    Some people get keloids when serious acne clears or chickenpox fade. It’s also possible to get a keloid after getting an insect bite or shot for a vaccine.

    Wearing tightly braided hair causes keloids in a few people.

    Some men who shave their face develop keloids in their beard area.

    It’s also possible for keloids to form on uninjured skin. These keloids are called “spontaneous keloids.” They usually appear on the chest and develop in people who have a family history of developing keloids. When keloids develop spontaneously, it’s more likely that several keloids will appear.

    It’s still not clear why some people’s skin scars this way.

    To discover why some people develop keloids, dermatologists continue to study these scars. Finding the cause could lead to better treatment and more-effective ways to prevent keloids.


    References
    Burton CS and Escaravage V. “Hypertrophic scars and keloids.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1497.

    Daggett A, Congcharoen J, et al. “Top 10 things you need to know about keloids and their treatment.” J Miss State Med Assoc. 2016;57(4):108-11.

    Kelly AP. “Keloids” In Kelly AP, Taylor SC, et al. Dermatology for Skin of Color. The McGraw Hill Companies, China, 2009. 178-94.

    Madu P and Kundu RV. “Follicular and scarring disorders in skin of color: presentation and management.” Am J Clin Dermatol. 2014 Aug;15(4):307-21.


    Keloids
    Save
  • Treatment

    Keloids: Diagnosis, treatment, and outcome

    How do dermatologists diagnose keloids?

    A dermatologist can usually diagnose a keloid by looking at it.

    If a keloid looks like a worrisome skin growth, a dermatologist may perform a skin biopsy. This involves removing a small section so that it can studied under a microscope. A dermatologist can quickly and easily remove a small section during an office visit.

    How do dermatologists treat keloids?

    To give their patients the best results, dermatologists may recommend more than one type of treatment for a keloid. These scars can be difficult to get rid of, and some return after treatment. Using two or more types of treatment often improves results.

    If you’ve had keloid treatment before, make sure your dermatologist knows.

    keloids-treatment.jpg

    Before your appointment with a dermatologist, it’s helpful to think about what you expect from treatment. Think how you would answer the following questions:

    • Is easing a symptom like pain or itch most important to you?
    • Will flattening or softening the keloid help you feel better?
    • If you have a keloid on your ear, is your primary goal to wear earrings again?

    Knowing what you expect will help your dermatologist provide you with realistic information about what treatment can do. It will also help your dermatologist create your treatment plan.

    A treatment plan for keloids may include:


    Injections of corticosteroids and other medicines: These injections are often part a treatment plan for keloids. When injected into the keloid, these medicines help to shrink the scar.

    Patients usually receive a series of injections once every 3 to 4 weeks. On average, patients return about 4 times for these injections. The first injections tend to relieve symptoms and make the keloid feel softer.

    Between 50% and 80% of keloids shrink after being injected. Many of these keloids, however, will regrow within 5 years. To improve results, dermatologists often add another therapy to the treatment plan.

    Surgical removal (keloid surgery): This treatment involves surgically cutting out the keloid. While this may seem like a permanent solution, it’s important to know that nearly 100% of keloids return after this treatment.

    To reduce the risk of a keloid returning after surgical removal, dermatologists often treat patients with another keloid treatment after the surgery. Injections of corticosteroids or cryotherapy may help reduce the risk. If the keloid is on an earlobe, wearing a special earring that puts pressure on the earlobe can prevent the keloid from returning.

    Receiving radiation treatments after surgical removal may also prevent a keloid from returning.

    Pressure earring, dressing, or garment: This is often used after keloid surgery. Putting pressure on the area reduces blood flow, which can stop a keloid from returning.

    Between 90% and 100% of patients who use this treatment as directed after keloid surgery can prevent another keloid.

    Using this as directed, however, can be difficult. These devices tend to be uncomfortable. To get results, a patient must wear it for up to 16 hours a day for 6 to 12 months.

    The pressure earring tends to be easiest to wear. It is often recommended after a dermatologist removes a keloid from an earlobe.

    Laser treatment: This can reduce the height and fade the color of a keloid. It’s often used along with another treatment like a series of corticosteroid injections or pressure.

    Silicone sheets and gels: These may be used along with pressure to prevent a keloid from returning.

    Sometimes, silicone is used alone to flatten a keloid. In one study, 34% of the raised scars had some flattening after patients used the silicone gel daily for 6 months.

    Cryotherapy: This treatment freezes the keloid from the inside out while saving the skin beneath the keloid. It’s used to reduce the hardness and size of a keloid. Cryotherapy works best on small keloids.

    Having a few cryotherapy treatments before (or after) receiving injections of corticosteroids may reduce the size of a keloid. This can make the injections more effective.

    Dermatologists have found that patients who have 3 or more cryotherapy treatments tend to get the best results.

    Radiation treatments: Getting radiation therapy after your dermatologist surgically removes the keloid may prevent the keloid from returning. Patients may begin radiation treatments immediately after keloid surgery, the next day, or a week later.

    Radiation may also be used alone to reduce the size of a keloid. Results, however, tend to be better when it’s used after keloid surgery.

    Ligature: If a surgical thread can be tied around the keloid, your dermatologist may recommend this treatment. The surgical thread will gradually cut into the keloid, which can cause it to fall off. You’ll need to tie a new surgical thread around the keloid every 2 to 3 weeks.

    Other treatments: To improve results, dermatologists are studying new treatments. To give you the best results, your dermatologist may recommend another treatment option.

    What is the outcome after treatment for a keloid?

    Treatment can reduce the size of keloid. It can reduce symptoms like pain and itch. Sometimes, treatment gets rid of a keloid.

    Even after successful treatment, some keloids return. Following your dermatologist’s instructions can help you reduce the chance of a keloid returning. It will also help you get the best results from treatment.


    References
    Burton CS and Escaravage V. “Hypertrophic scars and keloids.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1499-1502.

    Daggett A, Congcharoen J, et al. “Top 10 things you need to know about keloids and their treatment.” J Miss State Med Assoc. 2016;57(4):108-11.

    Kelly AP. “Keloids” In Kelly AP, Taylor SC, et al. Dermatology for Skin of Color. The McGraw Hill Companies, China, 2009. 178-94.

    London, S. “Management of keloids draws on clinical wisdom.” Dermatology News (Digital Network). 2013 Nov 1 2013. Last accessed September 30, 2016.

    Son D and Harijan A. “Overview of surgical scar prevention and management.” J Korean Med Sci. 2014;29(6):751-7.


    Keloids
  • Tips

    Keloids: How to prevent these raised scars

    keloid-earlobe.jpg
    This keloid developed after she had her ears pierced: Wearing a pressure earring immediately after she noticed her skin start to thicken may have prevented this keloid.

    If you have (or had) a keloid, you have a higher risk of getting another one.  You also have a higher risk if one (or more) of your parents, siblings, or children has (had) a keloid.

    The good news is that there are things you can do to reduce your risk of getting a full-blown keloid. Below you’ll find 4 common causes of keloids and what you can do to prevent each from causing a keloid.

    1. Ear piercing: Pay close attention to your ears after getting a new piercing. If you notice the skin on an earlobe start to thicken, you may be able to prevent a keloid if you act quickly. At the first sign of thickening, immediately remove the earring and start wearing a pressure earring instead.

      To get the best results, you’ll need to wear the pressure earring for at least 12 (and preferably 20) hours a day for 4 to 6 months. You’ll find pressure earrings available online.

      Because you cannot wear another earring under a pressure earring, your pierced hole will likely close if it’s new. Dermatologists caution against getting your ears pierced again. You’ll likely develop another keloid.

    2. Tattoo, body piercing, or cosmetic surgery: Try a test spot first. You can see how your skin will heal by getting a small amount of work done in a test area first. If the skin in the test area starts to thicken, you’ll know that the work could cause a keloid.

      Wearing a pressure garment can prevent thickening skin from turning into a keloid. To be effective, you need to start wearing it as soon as you notice thickening skin. A dermatologist can fit you with a pressure garment. Other treatment may also help.

    3. Surgery: If you have (or had) a keloid, tell your surgeon before the surgery. There may be a technique that your surgeon can use to reduce the likelihood that you’ll develop a keloid after surgery.

      If you notice the surgical scar thickening, starting keloid treatment immediately may help prevent a keloid. A dermatologist can create a keloid treatment plan for you.

    4. Injured skin: Follow these wound-care tips. The right wound care can reduce your risk of developing a keloid after you injure your skin.

      Supplies you need:

      If you injure your skin, you’ll want to get the following:
    • Sterile petrolatum gauze
    • Hydrogel wound dressing
    • Silicone sheets or gel
    • Sunscreen with SPF 30, broad-spectrum protection, and water resistance

    Wound care:

    • Wash the area immediately with soap and water. Keeping the wound clean helps to reduce scarring. When cleaning the wound, you want to avoid using hydrogen peroxide, rubbing alcohol, or iodine. These can be too drying. Soap and tap water or saline solution will cleanse without drying the wound.

    • Bandage the area with sterile petrolatum gauze. You want to keep wounds moist.

    • Gently cleanse the wound every day until it heals. You want to avoid scrubbing, which can cause a scar.

    • Protect the wounded skin from the sun. Studies show that ultraviolet (UV) light from the sun can increase scarring and darken the scar. You can prevent this by covering the newly wound skin with a bandage and clothing.

      Keloids can take time to appear. UV light from the sun can cause healed skin to darken and thicken. Once the wound heals, wearing sunscreen can help prevent this. You’ll want to apply the sunscreen when the wound isn’t covered by clothing or a silicone sheet.

      To get the protection you need, use a sunscreen that offers SPF 30 or higher, broad-spectrum protection, and water resistance.

    • As soon as the wound heals, begin using silicone sheets or gel. Applying silicone sheets or gel can help prevent keloids from forming and reduce the size of existing scars. You can buy these products without a prescription.

    If you have a severe injury like a bad burn, seeking medical care can give you the best outcome.

    keloids-tips.jpg

    Partner with a dermatologist

    These doctors are the skin experts. If you are concerned about thickening skin or an existing scar, a dermatologist can create a treatment plan tailored to your needs.


    References
    Daggett A, Congcharoen J, et al. “Top 10 things you need to know about keloids and their treatment.” J Miss State Med Assoc. 2016;57(4):108-11.

    Kelly AP. “Keloids” In Kelly AP, Taylor SC, et al. Dermatology for Skin of Color. The McGraw Hill Companies, China, 2009. 178-94.

    Meaume S, Le Pillouer-Prost A, et al. “Management of scars: Updated practical guidelines and use of silicones.” Eur J Dermatol. 2014;24(4):435-43.

    Monstrey S, Middelkoop E, et al. “Updated scar management practical guidelines: Non-invasive and invasive measures.” J Plast Reconstr Aesthet Surg. 2014;67(8):1017-25.

    Son D and Harijan A. “Overview of surgical scar prevention and management.” J Korean Med Sci. 2014; 29(6): 751–757.

    Tanaydin V, Beugels J, et al. “Efficacy of custom-made pressure clips for ear keloid treatment after surgical excision.” J Plast Reconstr Aesthet Surg. 2016;69(1):115-21.


    Keloids