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Keloids are an aggressive form of scars that usually develop due to excessive growth of thick, fibrous tissues over the site of a wound.
Although a rarity, a keloid can develop without any skin injury in some people. An anomaly of this kind is referred to as a spontaneous keloid since there is no physical cause behind it.
Keloids can be of varying shapes and sizes, depending upon the site of scarring. For instance, they tend to manifest as a localized round mass of solid tissue on an earlobe, but they appear more spread out on the skin of the chest and shoulders.
Keloids can be quite an eyesore and make one conscious about one’s physical appearance. Besides the emotional distress, keloids can become considerably painful and itchy as they continue to grow.
Large-sized keloids or those that form over a joint can be quite debilitating by hampering the mobility of the affected area. However, one can rest assured that, threatening as they may appear, these scars do not pose any risk of turning cancerous.
Causes of Keloids
In the event of a superficial injury, the skin tries to heal itself by producing an increased amount of collagen at the affected site. This leads to the formation of scar tissue over the wound to prevent further damage to the affected skin.
In some cases, extra layers of scar tissue keep piling up even after the skin has repaired itself completely. The resultant scar, thus, becomes more enlarged than the actual injury and is referred to as a keloid.
Such excessive tissue growth is usually noticed in the case of acne, piercings, minor burns, tattoos, chickenpox, bites, scrapes, cuts, and surgical incisions.
However, there have been instances when even a mere scratch has led to the formation of a keloid. Due to the superfluous growth of thick skin tissue at the site of injury, the scar tends to appear abruptly above the skin.
The exact cause behind this type of abnormal skin healing is still unidentified, but it may be linked to certain genetic factors. People with a family history of keloid formation tend to be more prone to this condition.
Moreover, keloids are more prevalent among dark-skinned individuals and rarely develop in people with a lighter complexion.
Signs and Symptoms of Keloids
Keloids are characterized by the following:
- Keloids can vary in color, ranging from a pinkish flesh color to a deeper red or purple.
- Keloids can form anywhere on the body where the skin tissue has been wounded or injured, but some areas are more prone to this type of scarring, which includes the chest, shoulders, cheeks, upper back, and earlobes.
- Keloids may not develop soon after the skin damage, and it can take anywhere between 3 months and a year for the first sign of scarring to appear.
- Keloids usually have a lumpy or jagged feel.
- Keloids appear elevated than the surrounding skin and typically have a smooth surface.
- Keloids are usually tender to the touch.
- Keloids can be intensely itchy overtime.
- Keloids are often firmer than the surrounding skin but become softer and more compressible with treatment.
- Keloids tend to get easily irritated from any kind of surface friction, even by rubbing against a coarse fabric.
- A keloid can be sensitive to the sun, especially during the first year after its formation. The scar tends to get much more easily and deeply tanned than the skin around it, and the discoloration may be very difficult to undo.
Diagnosis of Keloids
Diagnosing a keloid is a pretty straight-forward task for a skin specialist with a trained eye: one look at the scar and your doctor can immediately tell if it is a keloid or not.
After a thorough physical and visual examination, the doctor will inquire about any tissue injury that you may have suffered in the past, such as on account of a surgical operation, acne breakout, or body piercing.
This line of questioning will steer the doctor toward a probable cause for this type of scarring.
If there is still some uncertainty regarding the diagnosis, your doctor will conduct a biopsy of the scar tissue, wherein a small sample of the affected skin will be closely examined under a microscope. In most cases, however, the need for such extensive analysis does not arise.
The standard treatment for keloids involves both surgical and as nonsurgical options. Some of the most commonly used methods for improving the appearance of your scar or the complete removal of the keloid are as follows.
1. Over-the-Counter Topical Treatments
Silicone-containing topical products that are easily available without a prescription continue to be one of the most successful first-line treatment options for keloid scars.
Silicone penetrates deep into the damaged tissue and attaches to it at the molecular level to create a sort of tension on the epidermal surface. It is by this mechanism that silicone helps shrink the extra layers of scar tissue accumulated at the site of injury and thwart excessive collagen synthesis.
Topical application of silicone-based products on a skin wound can also speed up the healing of damaged blood vessels, which can further deter the formation of keloids.
Silicone products are helpful in reducing the appearance of different kinds of scars, which include both keloids and hypertrophic scars as well as old and new ones. This type of topical therapy rarely presents any adverse side-effects. Thus, it is generally considered safe for people of all ages and skin color. (4)
Silicone products for scar treatment include:
- Emollients in the form of creams and oils
- Polyurethane or silicone scar-reduction patches
- Oral or topical tranilast
- Silicone-based topical gel
- Pressure dressings/patches
2. Steroid Injections
Another standard treatment to make the keloid less noticeable is directly injecting a long-acting corticosteroid solution into the scar.
In the initial phase of keloid formation, your dermatologist will administer a single cortisone injection every month, and the scar will gradually regress after multiple doses. The improvement in your skin condition will most likely become visible after at least 3 – 6 months of starting this course.
When injected into the skin, the steroids work by splitting the links between collagen fibers. This mechanism helps breakdown the accumulated scar tissue under the skin.
Steroids are also credited with a potent anti-inflammatory action that can help provide symptomatic relief from the itching, redness, swelling, and tenderness that usually accompany keloid formation.
Steroid injections are routinely given to people who may show a tendency for keloid formation before they undergo any form of surgery. The purpose behind this is purely preventative since surgical cuts are some of the most common contributors to keloid scarring.
By injecting steroids into the area that needs to be operated upon, the risk of keloid formation may not be completely averted, but it can be reduced. If nothing else, presurgical steroid injections may help constrict the size of the scar that develops thereafter.
3. Direct Surgery
If nonsurgical treatment fails to remove or diminish the appearance of keloid scars, you may have to consider more invasive options such as surgery.
Direct surgery is usually preferred in addressing more severe scarring and involves making an incision into the affected site to remove the extra layer of scar tissue and then tying up the open cut with stitches.
Yet another fairly noninvasive therapy involves the use of cold therapy to freeze the scar tissue before removing it from the body. Liquid nitrogen is typically used for this purpose. This treatment method works primarily for small-sized keloids and is particularly effective for light-skinned patients. (6)
The person undergoing this procedure is given a medication to freeze the scar, which will then become increasingly inflamed and purulent before shrinking into a dark-colored scab. Over time, the scab will detach itself from the live skin and fall off.
If this does not happen, the scar tissue may have to be surgically excised. Cryosurgery is often paired with a monthly dose of cortisone injections.
5. Laser Surgery
Laser surgery is not a standalone treatment for keloids, but it works in conjunction with several other therapeutic tools such as steroid injections, silicone bandaging, and the use of specialized dressings. Your dermatologist will decide which type of laser beam to use, depending upon the underlying cause of the scar.
Laser therapy can serve different purposes, but people generally opt for this procedure to improve the appearance of their scarred skin. The laser can help reduce the height of the scar, make the scar visibly smoother, or fade the abnormal discoloration of the scar.
Home Remedies for Keloids
A few natural ingredients may help improve the appearance of stubborn scars such as keloids, but bear in mind that these remedies do not offer a permanent cure or complete scar removal.
At best, these home treatments are intended to relieve the symptomatic discomfort associated with keloids, make it less apparent, and keep it from growing further.
1. Preventive Self-Care Tips
The risk of excessive tissue growth after a skin injury can be minimized with the help of a few self-care or preventative measures:
- People who tend to develop keloids need to be extra cautious. There is only so much you can do to keep yourself free of skin injuries, but obligatory precaution dictates that you must avoid any kind of deliberate trauma to the skin.
To that end, getting your skin pierced or tattooed is strictly prohibited. If you can, avoid surgical procedures that may result in such intensive scarring.
- If you incur a minor skin injury, prompt treatment will help the damaged tissue heal faster, thereby limiting the extent of scarring and the formation of keloids.
- If you have a fresh wound, apply a thin layer of an emollient such as petroleum jelly on top of it and cover the area with a nonstick bandage.
Use an adhesive tape to secure the bandage in place and maintain an even pressure all over the injured site. It is also recommended to change the dressing of the wound daily after cleaning it with antibacterial soap and water.
- Because a keloid can appear even after your wound has healed completely, it is recommended to use a bit of pressure therapy to avoid this outcome.
This involves wearing a silicone gel bandage over the wound to exert an even pressure over the area of the scar. You are usually required to keep the bandage on day and night for at least 2 to 3 months.
- If you decide to get an ear piercing, it may be wise to use pressure earrings or Zimmer splints to keep the damaged tissue compressed and prevent the growth of keloids. (5)
The skin-healing property of honey has made it one of the most sought-after ingredients for topical remedies. This natural humectant can help restore moisture to your skin and help repair tissue damage if used regularly.
Honey may work as an organic emollient to relieve the skin irritation associated with keloids and may even hold some promise in diminishing the appearance of the scar.
The findings of a 2011 study suggested that honey may exhibit a positive antiproliferative effect that curbs the growth of keloid fibers. Tualang honey was found to be especially potent in this regard, as it contains a range of volatile compounds that may inhibit skin cell proliferation at the site of scarring. (1)
However, it is important not to overestimate the skin-healing property of honey for keloid management. The best you can expect is a slight reduction in the size of the scar, but there is no guarantee that the keloid will not grow back or reappear.
The currently available research is not sufficient to decidedly establish the efficacy of using honey as a topical tool for scar reduction. The antiproliferative activity attributed to honey needs to be validated by more extensive and rigorous studies.
You can gently massage some fresh tualang honey on the scar to improve blood circulation in the area, which may help decrease the accumulation of dead skin cells.
Honey is regarded as a mild and moisturizing skin salve that is associated with little to no adverse side-effects. It may help calm your irritated skin and suppress the excessive growth of malignant cells into surrounding tissue, but it does not offer a permanent cure to skin scarring. While honey has demonstrated some antiproliferative effect, it needs further scientific validation to be advocated for large-scale therapy.
Topical application of garlic may help fade scars over time. This claim is hinged upon the ability of garlic to diminish the production of excessive collagen at the site of skin injury, which ultimately results in keloid formation.
This is further corroborated by a 2011 review of garlic’s use in dermatology, which supports the use of garlic as an effective topical aid to reduce the appearance of keloid scars. (2)
Garlic has a long history of being extensively used in the field of dermatology, but whether or not it works for keloid treatment is still subject to further investigation. There is some scientific evidence in favor of using garlic to reduce collagen synthesis and fibroblast proliferation, but more direct researches are needed to establish its positive effects on keloid scars.
4. Onion Extract
In a 2013 review, a number of recent studies have shown that the topical administration of onion-extract-based creams on keloids may help flatten the scar to make it less noticeable, as opposed to no treatment at all. (3)
This scar-healing potential can be traced back to certain flavonoids found in onion extracts that may help inhibit the fibroblast proliferation and excessive collagen synthesis responsible for keloid formation.
The regular application of an ointment containing onion extracts may help slow down the buildup of scar tissue, but only to a small degree. There isn’t enough scientific proof to confirm this claim, but topical use of onion extract may still be a better option than no treatment at all.
Do Keloids Progressively Grow or Reoccur?
Keloids result from an increased accumulation of collagen, which can continue for several years, making the scar appear progressively enlarged and raised over time.
In some cases, the scar may become visible more than 3 months after the actual injury, and you cannot rule out the possibility of it coming back even after being treated. The probability of recurrence tends to be greater after having the scar surgically removed.
Keloids Versus Hypertrophic Scars
Keloids bear a fetching resemblance to yet another category of scars known as hypertrophic scars, but there are some distinguishing factors between the two:
- Unlike keloids, hypertrophic scars are prevalent in almost all racial groups and skin color.
- Another key difference between the two is that hypertrophic scarring is usually limited to the site of the injury and tends to fade with time, whereas keloids tend to expand beyond the site of injury and continue to grow rather than regress overtime.
- Hypertrophic scars are also much more common than keloids.
- There is a telling difference between the collagen patterns of these two distinct scars. While keloids do not have a set pattern or shape of collagen arrangement, hypertrophic scars are characterized by increased collagen fibers that become settled in a layer parallel to the dermis.
Who Is at Risk?
Some people have an increased tendency to develop keloids than others. These include the following groups:
- People of African-American descent show increased susceptibility to this skin condition.
- People who fall in the age bracket of 10 to 30 years are at an increased risk of developing keloids.
- Although keloids tend to affect both men and women equally, a higher incidence may be reported among young women who have their ears pierced.
- People who have undergone an open-heart surgery are more likely to develop keloids over the site of incision, typically over the breastbone.
- Some people are genetically predisposed to scarring and therefore are at a greater risk of keloid formation.
When to Call a Professional
Keloids are categorized as benign tumors that are unlikely to turn malignant. Even though they do not qualify as a major health concern, keloids figure as a legitimate cosmetic nuisance, especially if they occur on the visible parts of the body.
You are advised to consult a skin specialist if the condition becomes particularly bothersome, on account of the following reasons:
- The scar becomes particularly enlarged.
- The scar becomes excessively itchy and uncomfortable.
- The scar develops on a joint such that it impedes your movement.
- The scar makes you feel extremely conscious and starts affecting your emotional and mental well-being.
Expert Answers (Q&A)
Answered by Dr. Niyati Sharma, MBBS (Dermatology)
No, it’s a permanent scar.
Yes, especially if you continue to rub it.
Yes. If you have a tendency to have keloids, avoid any cosmetic or other unnecessary procedures.
Otherwise, at the time of surgery, your surgeon or dermatologist should insert intralesional cortisone to prevent them from occurring.
No, there is no such link. If however you have had no procedure done or had no acne in that area and the scar occurred spontaneously, please see your dermatologist, as it could be a cancer growth.
Yes, that’s how it typically occurs or sometimes even due to severe forms of acne.
The best treatment so far is the intralesional cortisone that is done every 6 weeks. This is where cortisone is injected into the keloid via a small (diabetic) syringe.
Avoid rubbing keloids, as this can aggravate them. Keep them protected from the sun and avoid any unnecessary procedures in the first place.
If you have acne, and you are forming keloids, treat acne aggressively with the help of your dermatologist.
About Dr. Niyati Sharma, MBBS: Dr. Sharma completed her MBBS from the University of Adelaide, Australia in 2007. She completed her Pediatrics Dermatology Fellowship in 2018 from Ann & Robert Lurie Children’s Hospital, USA.
Dr. Sharma currently sees patients at Monash Health, Victoria, Australia.