Keloids: Causes, Symptoms, and Treatment

What is Keloids?

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 composed of dense, fibrous tissue and can be itchy, tender, or painful. Keloids are more common in people with darker skin tones and can develop anywhere on the body, though they often appear on the ears, chest, shoulders, and cheeks.

According to the Mayo Clinic, keloids are not harmful to general health but can cause cosmetic concerns and, in some cases, affect mobility if they form over a joint.

Common Causes

Keloids can develop from various types of skin injuries. Here are some of the most common causes:

• Surgical incisions: Cuts made during surgery can lead to keloid formation, especially in individuals prone to them.
• Acne scars: Severe acne can leave behind keloids, particularly on the face, chest, and back.
• Burns: Thermal, chemical, or radiation burns may result in keloid scars as the skin heals.
• Piercings: Ear piercings and other body piercings are common sites for keloid development.
• Vaccination sites: Some people develop keloids at the site of vaccinations or injections.
• Chickenpox scars: The scars left by chickenpox can sometimes become keloids.
• Trauma or cuts: Any deep cut or scrape can potentially lead to a keloid if the person is susceptible.
• Tattoos: The needle punctures from tattoos can sometimes trigger keloid formation.
• Insect bites: Scratching or irritation from insect bites can lead to keloids in some cases.
• Minor skin irritations: Even small irritations like ingrown hairs or minor scratches can cause keloids in prone individuals.

The National Institutes of Health (NIH) notes that keloids are more likely to form in areas of the body with high skin tension, such as the chest or shoulders.

Associated Symptoms

Keloids can present with a variety of symptoms, which may include:

• Raised, thickened skin: Keloids are typically raised above the surrounding skin and have a firm, rubbery texture.
• Shiny or glossy appearance: The surface of a keloid may appear shiny due to the dense collagen fibers.
• Itching or discomfort: Many keloids are itchy, and some may cause a burning or tender sensation.
• Redness or hyperpigmentation: Keloids can be red, pink, or darker than the surrounding skin, depending on the individual's skin tone.
• Growth over time: Unlike normal scars, keloids can continue to grow slowly for months or even years.
• Pain or tenderness: Some keloids may be painful, especially if they are located over a joint or an area subject to friction.
• Restricted movement: If a keloid forms over a joint, it may limit mobility due to its size and stiffness.

The Centers for Disease Control and Prevention (CDC) emphasizes that while keloids are benign, their symptoms can significantly impact a person's quality of life.

When to See a Doctor

You should consult a healthcare provider if you notice any of the following:

• A scar that continues to grow beyond the original wound site.
• Persistent itching, pain, or discomfort associated with a scar.
• A scar that becomes increasingly red, tender, or warm to the touch, as this could indicate an infection.
• Difficulty moving a joint due to a scar.
• Emotional distress or self-consciousness caused by the appearance of the scar.

Early intervention can help manage symptoms and prevent the keloid from growing larger. The Cleveland Clinic recommends seeking medical advice if you are prone to keloids and have a new skin injury to discuss preventive measures.

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 distinct appearance. However, in some situations, a doctor may perform the following:

• Medical history review: The doctor will ask about past injuries, surgeries, or skin conditions that may have led to the keloid.
• Physical examination: The healthcare provider will assess the size, shape, color, and texture of the scar.
• Biopsy (rarely): If there is any doubt about the diagnosis, a small tissue sample may be taken for laboratory analysis to rule out other conditions, such as skin cancer.

The World Health Organization (WHO) notes that keloids are usually diagnosed clinically, and further testing is uncommon unless there are atypical features.

Treatment Options

Treating keloids can be challenging, and no single treatment works for everyone. A combination of approaches is often necessary. Here are some common treatment options:

Medical Treatments

• Corticosteroid injections: These are often the first line of treatment. Injections of corticosteroids (like triamcinolone) can help reduce inflammation, itching, and the size of the keloid. Multiple sessions may be required.
• Surgical removal: While surgery can remove a keloid, there is a high risk of recurrence. Surgery is often combined with other treatments, such as steroid injections or radiation, to reduce the chance of the keloid returning.
• Laser therapy: Lasers can help flatten and reduce the redness of keloids. This treatment is often used in combination with other therapies.
• Cryotherapy: Freezing the keloid with liquid nitrogen can help reduce its size and relieve symptoms. This method is often used for smaller keloids.
• Radiation therapy: Low-dose radiation can be used after surgical removal to prevent recurrence. This is typically reserved for severe or recurrent cases.
• Pressure therapy: Applying pressure to the keloid with specialized dressings or garments can help flatten it over time. This is often used after surgery.
• Silicone gel or sheets: These can be applied to the keloid to help soften and flatten it. Silicone treatments are non-invasive and can be used long-term.

Home Treatments

While home treatments alone may not eliminate keloids, they can help manage symptoms and improve appearance:

• Massage: Gently massaging the keloid with a moisturizing cream or oil may help soften the tissue and reduce itching.
• Over-the-counter creams: Creams containing onion extract (like Mederma) or silicone may help reduce the appearance of keloids.
• Aloe vera: Applying aloe vera gel may soothe itching and reduce inflammation, though it is unlikely to shrink the keloid significantly.
• Honey: Some people find that applying honey to the keloid helps with hydration and reduces irritation.

The NIH suggests that while home remedies can provide symptomatic relief, medical treatments are usually necessary for significant improvement.

Prevention Tips

Preventing keloids can be challenging, especially for individuals who are genetically predisposed. However, the following tips may help reduce the risk:

• Avoid unnecessary skin trauma: Be cautious with activities that could lead to cuts, burns, or piercings, especially in areas prone to keloids.
• Treat wounds promptly: Clean and care for any skin injuries immediately to promote proper healing. Keep wounds moist and covered with a bandage.
• Avoid picking at scabs or acne: Picking can increase the risk of scarring and keloid formation.
• Use pressure or silicone treatments: If you are prone to keloids, applying silicone sheets or pressure dressings to healing wounds may help prevent keloid formation.
• Consider steroid injections for high-risk wounds: If you have a history of keloids, your doctor may recommend corticosteroid injections at the site of a new injury to prevent keloid development.
• Choose piercings carefully: If you decide to get a piercing, opt for areas with lower skin tension, such as the earlobe, and avoid high-risk areas like the cartilage.
• Consult a dermatologist: If you are prone to keloids, a dermatologist can provide personalized advice on prevention and early treatment.

The American Academy of Dermatology (AAD) recommends being proactive about wound care and seeking professional advice if you are at high risk for keloids.

Emergency Warning Signs

While keloids themselves are not medical emergencies, certain signs may indicate a complication that requires immediate attention:

• Signs of infection: If the keloid becomes increasingly red, swollen, warm, or starts oozing pus, seek medical help immediately. These could be signs of an infection that requires antibiotics.
• Severe pain: While some discomfort is normal, severe or worsening pain could indicate an underlying issue, such as an infection or nerve involvement.
• Rapid growth: If the keloid suddenly grows very quickly, consult a healthcare provider to rule out other conditions, such as skin cancer.
• Ulceration or bleeding: If the keloid develops open sores or starts bleeding without injury, seek medical evaluation.
• Systemic symptoms: If you develop a fever, chills, or other signs of systemic illness along with changes in the keloid, it could indicate a serious infection that requires urgent care.

If you experience any of these emergency warning signs, contact your healthcare provider or go to the nearest emergency room immediately.

For more information on keloids, visit reputable sources like the Mayo Clinic, NIH, or Cleveland Clinic.