Keloids

This is not fully understood, but keloids happen when there is over production of collagen (the skin's structural protein). They are not contagious. They can affect anyone, but they are more common in some groups (e.g. people of African, Asian, or Hispanic descent). Only a minority of people develop keloids. There are some risk factors that increase the likelihood of a person developing keloids.

Keloid scars:

• are more common after skin injury on the upper chest, breastbone (sternum), shoulders, chin, neck, lower legs and earlobes (especially after ear piercing)
• are most likely to form following burns, acne scars and wounds that become infected or where the skin becomes significantly tight whilst healing
• may develop from surgical scars
• are more likely to affect people who have previously had a keloid if their skin is damaged again
• most commonly arise between puberty and 30 years of age
• may appear or enlarge during pregnancy.

Are keloids hereditary?

Not usually, but the tendency to develop keloids can run in families. Studies have shown that 5-10% of Europeans with keloids have a positive family history (at least one other member of their family has keloids).

While keloids are growing, they may feel itchy, prickly and/or sore. Once they have stopped growing there is usually no discomfort. If they are located over or near a joint, they can restrict movement.

What does a keloid look like?

Keloids are enlarged, raised scars. They can be skin-coloured, pink/red/maroon, or darker than the surrounding skin. They usually feel firm and smooth. They are shiny and hairless. A keloid can appear within 3-4 weeks of a skin wound but can take a year or longer to appear. A keloid may continue to grow for months or years. Multiple keloids may develop, especially after acne or chickenpox, although most people only have one or two.

Image DermNetNZ.

The doctor will usually make the diagnosis of a keloid just by looking at the skin; so no tests are needed. If the diagnosis is uncertain, a skin biopsy can be taken (a procedure in which a small sample of skin is removed from the affected area under local anaesthetic, processed, and examined under a microscope).

Can a keloid be removed?

Surgically removing/excising (cutting out) a keloid is rarely a success as this can cause a larger wound and the keloids is likely to regrow in it. If it is excised, the risk of regrowth may be reduced by compression dressings or steroid injections following the procedure (see below).

How can a keloid be treated?

Unfortunately, there is no cure for keloids. Treatment can sometimes help to flatten them and reduce irritation. There is currently no evidence that any single form of treatment is better than another and keloids often regrow in the same place. Treatment options include:

For people at increased risk of developing keloids or those already affected by keloids, it is advisable to avoid skin trauma where possible (e.g. tattooing, body piercing and unnecessary surgical procedures). This is particularly important for high-risk areas such as the chest and earlobes. In the case of acne, prompt and effective medical therapy is important to limit the risk of scarring.