Keloid Formation: Causes, Symptoms, and Treatment

What is Keloid Formation?

A keloid is a type of raised scar that occurs when the skin heals after an injury. Unlike normal scars, which tend to fade over time, keloids grow beyond the boundaries of the original wound and do not regress. They are benign (non-cancerous) but can be cosmetically concerning and sometimes painful or itchy.

Keloids are composed of collagen, a protein that the body produces to repair skin damage. In keloids, the body produces excess collagen, leading to a thick, raised scar that can vary in size, shape, and color. They are more common in people with darker skin tones and can appear anywhere on the body, though they are most frequently found on the chest, shoulders, earlobes, and cheeks.

Source: Mayo Clinic, National Institutes of Health (NIH)

Common Causes

Keloids can form after any type of skin injury. Some of the most common causes include:

• Surgical incisions: Cuts made during surgery can lead to keloid formation, especially in individuals prone to keloids.
• Acne scars: Severe acne, particularly cystic acne, can leave behind keloids as the skin heals.
• Piercings: Earlobe piercings and other body piercings are common sites for keloid development.
• Burns: Thermal, chemical, or friction burns can result in keloids during the healing process.
• Chickenpox scars: Scratching chickenpox blisters can lead to keloid formation as the skin repairs itself.
• Vaccination sites: Injections or vaccinations can sometimes trigger keloid growth.
• Trauma or cuts: Any deep cut, scrape, or abrasion can potentially develop into a keloid.
• Tattoos: The needle punctures from tattoos can cause keloids in susceptible individuals.
• Insect bites: Scratching or irritating insect bites can lead to keloid formation.
• Genetic predisposition: A family history of keloids increases the likelihood of developing them.

Source: Centers for Disease Control and Prevention (CDC), Cleveland Clinic

Associated Symptoms

Keloids are primarily characterized by their appearance, but they can also cause other symptoms, including:

• Raised, thickened skin: Keloids are typically firm and rubbery to the touch, with a shiny, smooth surface.
• Discoloration: They may be pink, red, or darker than the surrounding skin, depending on the individual's skin tone.
• Itching or irritation: Keloids can be itchy, tender, or painful, especially during their growth phase.
• Growth over time: Unlike normal scars, keloids can continue to grow slowly for months or even years.
• Restricted movement: If a keloid forms over a joint, it may limit mobility due to its size and stiffness.
• Cosmetic concerns: Keloids can be unsightly, leading to self-consciousness or emotional distress.

Keloids do not pose a serious health risk, but their symptoms can be bothersome. If you experience significant pain, rapid growth, or signs of infection (such as pus or increased redness), seek medical attention.

Source: World Health Organization (WHO)

When to See a Doctor

While keloids are not medically dangerous, you should consult a healthcare provider if you notice any of the following:

• The scar is growing rapidly or becoming increasingly painful.
• The keloid is located over a joint and is restricting movement.
• You experience signs of infection, such as warmth, redness, swelling, or pus.
• The keloid is causing significant emotional distress or affecting your quality of life.
• You have a family history of keloids and want to discuss preventive measures before undergoing surgery or piercings.

A dermatologist or plastic surgeon can evaluate the keloid and recommend appropriate treatment options based on its size, location, and severity.

Source: American Academy of Dermatology (AAD)

Diagnosis

Diagnosing a keloid typically involves a physical examination by a healthcare provider. In most cases, no additional testing is needed, as keloids have a distinctive appearance. However, in some situations, your doctor may recommend:

• Medical history review: Your doctor will ask about past injuries, surgeries, or skin conditions, as well as any family history of keloids.
• Biopsy (rarely): If the diagnosis is unclear, a small sample of the scar tissue may be taken for laboratory analysis to rule out other conditions, such as skin cancer or hypertrophic scars.
• Imaging tests (rarely): In some cases, imaging tests like ultrasound or MRI may be used to assess the depth and extent of the keloid, especially if it is large or located in a sensitive area.

Keloids are usually easy to distinguish from other types of scars due to their raised, thickened appearance and tendency to extend beyond the original wound site.

Source: National Center for Biotechnology Information (NCBI)

Treatment Options

Treating keloids can be challenging, and no single treatment works for everyone. A combination of approaches is often necessary. Treatment options include:

Medical Treatments

• Corticosteroid injections: These are the most common treatment for keloids. Injections of corticosteroids (such as triamcinolone) can help reduce inflammation, flatten the keloid, and relieve itching. Multiple sessions may be required.
• Surgical removal: Surgery can remove the keloid, but there is a high risk of recurrence (up to 50-100%). For this reason, surgery is often combined with other treatments, such as steroid injections or radiation therapy, to reduce the chance of the keloid returning.
• Laser therapy: Laser treatments, such as pulsed-dye laser or CO2 laser, can help flatten keloids and reduce redness. This method is often used in combination with other treatments.
• Radiation therapy: Low-dose radiation can be used after surgical removal to prevent recurrence. This is typically reserved for large or recurrent keloids.
• Cryotherapy: Freezing the keloid with liquid nitrogen can help flatten it. This method is often used for smaller keloids and may require multiple sessions.
• Pressure therapy: Applying pressure to the keloid with silicone gel sheets or pressure garments can help flatten it over time. This is often used after surgery or other treatments.
• Immunotherapy: Medications like interferon or 5-fluorouracil (5-FU) can be injected into the keloid to reduce its size and prevent recurrence.

Home and Alternative Treatments

• Silicone gel or sheets: Over-the-counter silicone products can help flatten and soften keloids when used consistently over several months.
• Onion extract (e.g., Mederma): Some studies suggest that onion extract may help reduce scar size and improve appearance, though results can vary.
• Massage: Gently massaging the keloid with moisturizing oils (such as vitamin E or coconut oil) may help soften the tissue and reduce itching, though it is unlikely to shrink the keloid significantly.
• Honey: Some people use medical-grade honey for its anti-inflammatory properties, though evidence for its effectiveness in treating keloids is limited.

It’s important to note that home remedies are generally less effective than medical treatments and may not work for everyone. Always consult a healthcare provider before trying new treatments, especially if you have sensitive skin or allergies.

Source: Mayo Clinic, PubMed Central

Prevention Tips

Preventing keloids can be challenging, especially if you are genetically predisposed to them. However, the following strategies may help reduce your risk:

• Avoid unnecessary skin trauma: Be cautious with piercings, tattoos, and elective surgeries if you have a history of keloids.
• Treat wounds promptly: Clean and cover cuts, scrapes, or burns immediately to minimize scarring. Keep the wound moist and avoid picking at scabs.
• Use pressure or silicone sheets: After surgery or injury, applying pressure or silicone gel sheets to the healing wound may help prevent keloid formation.
• Avoid sun exposure: Protect healing skin from the sun, as UV rays can darken scars and make them more noticeable.
• Consider preventive treatments: If you are undergoing surgery and are prone to keloids, ask your doctor about preventive measures, such as corticosteroid injections or radiation therapy immediately after the procedure.
• Manage acne carefully: Avoid picking or squeezing pimples, as this can lead to scarring and keloids. Seek treatment for severe acne from a dermatologist.
• Choose piercings wisely: If you decide to get a piercing, opt for areas with lower keloid risk (e.g., earlobes instead of cartilage) and follow aftercare instructions diligently.

If you have a family history of keloids, discuss prevention strategies with a dermatologist before undergoing any procedures that could lead to scarring.

Source: American Academy of Dermatology (AAD)

Emergency Warning Signs

While keloids themselves are not emergencies, you should seek immediate medical attention if you experience any of the following:

• Signs of infection: Increased pain, redness, swelling, warmth, or pus around the keloid. This could indicate a bacterial infection that requires antibiotics.
• Rapid growth or changes in appearance: If the keloid suddenly grows larger, changes color, or becomes extremely painful, it could signal an underlying issue.
• Bleeding: If the keloid starts bleeding without any apparent cause, see a doctor to rule out complications.
• Ulceration: Open sores or breakdown of the skin over the keloid may require medical intervention to prevent infection.
• Severe pain or restricted movement: If the keloid is causing significant pain or limiting your ability to move a joint, consult a healthcare provider for evaluation.

If you are unsure whether your symptoms warrant emergency care, err on the side of caution and contact a healthcare professional.

Source: Centers for Disease Control and Prevention (CDC)