Keloid
(Keloid Scar; Dermal Fibrotic Lesion; Hypertrophic Scar)
Pronounced: KEE-loyd
Definition
A keloid is a fleshy but firm raised area of skin. It develops when scar tissue from a healing injury, (eg, a deep skin wound) develops beyond the affected area. This results in a growth that can vary in size from one to several inches. Keloids are not harmful to general health.
Causes
For unknown reasons, scar tissue begins to form in an uncontrolled manner. Proteins continue to multiply after the wound has been covered. The process can continue for weeks or months. This is especially true for the following areas:
- Earlobes
- Shoulders
- Upper back
- Chest
- Back of scalp and neck
Risk Factors
Factors that increase your chance of keloids include:
- African American, Asian, or Hispanic ethnicity
- Between 10-30 years old
- Deep skin wounds, such as those from burns or surgical scars
- Scars from acne , vaccinations, or chickenpox
- Family history
Normal Surgical Scar
Symptoms
Keloids often begin as small lumps at the site of a skin injury. They gradually grow beyond the margins of the original wound. Keloids do not go below the surface.
Symptoms include:
- Pain
- Burning
- Itchiness
- Tenderness
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done.
You may be referred to a specialist. Dermatologists focus on the skin. They can confirm the diagnosis and assist in removal. A plastic surgeon may do the removal.
Tests may include a biopsy. This may be done to rule out tumor formation or other skin disorders.
Treatment
In very rare cases, some keloids dissolve on their own. However, in those at risk for keloid formation, it is common for a keloid to reappear after it has been removed. The main goals of keloid treatment are to:
- Remove the keloid to allow normal healing
- Stop the discomfort caused by pain, burning, itchiness, or tenderness
- Avoid recurrence
- Minimize scarring
Treatment options may vary. Your doctor may recommend more than one depending on your condition.
Corticosteroid Injections
These are made directly into the skin lesion. They are repeated every 3-4 weeks for six months. Steroids relieve itching and pain. They can slow down collagen formation. This will cause the keloid to shrink. This procedure may be combined with surgery to remove any remaining lesion.
Compression Dressings
This process is used to apply pressure to the keloid. The pressure will flatten it. The dressing is reapplied every 7-10 days. The treatment may continue over a period of 3-12 months.
Surgery
Surgery may be done to remove the keloid. It is often done in combination with corticosteroid injections.
Cryosurgery
This method is used to freeze small, contained lesions. Cryosurgery may be done in combination with corticosteroid injections.
Radiation Therapy
This therapy is highly successful. It is limited due to the toxicities.
Interferon-alfa
These injections may reduce recurrence rates after surgery.
Intralesional Fluorouracil
This drug may be of benefit for keloids.
Imiquimod
This cream has been used to prevent regrowth of keloids after removal.
RESOURCES:
American Academy of Dermatology
http://www.aad.org/
American Osteopathic College of Dermatology
http://www.aocd.org/
American Society of Plastic Surgeons
http://www.plasticsurgery.org/
CANADIAN RESOURCES
Canadian Dermatology Association
http://www.dermatology.ca/
Dermatologists.ca
http://www.dermatologists.ca/
References:
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Dermatologic disorders: keloid. The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.com/mrkshared/mmanual/section10/chapter125/125k.jsp . Accessed December 12, 2006.
Dermatologic disorders: keloid. The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.com/mrkshared/mmanual/section10/chapter125/125k.jsp . Accessed June 24, 2005.
Everyday wounds. Scars and keloids. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/medical_professionals/publications/Everyday-Wounds-Ch1 . Accessed June 24, 2005.
Keloids. British Association of Dermatologists website. Available at: http://www.bad.org.uk/public/leaflets/keloids.asp . Accessed December 12, 2006.
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Larson D. Preventing keloids. Medical College of Wisconsin website. Available at: http://healthlink.mcw.edu/article/996370237.html . Accessed December 12, 2006.
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Malaker K, Vijayraghavan K, Hodson I, Al Yafi T. Retrospective analysis of treatment of unresectable keloids with primary radiation over 25 years. Clin Oncol . 2004;16:290.
Newsome RE, Langston K, Wang A, Jansen D. Wound Healing, Keloids. eMedicine website. Available at: http://www.emedicine.com/plastic/topic404.htm . Accessed December 12, 2006.
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Scars don’t have to mark your skin. American Academy of Dermatology website. Available at: http://www.aae.org/public/news/newsreleases/scars_alster.htm . Accessed June 24, 2005.
Shaffer JJ, Taylor SC, Cook-Bolden F. Keloidal scars: A review with a critical look at therapeutic options. J Am Acad Dermatol . 2002; 46:S63.
Skin of color. American Academy of Dermatology website. Available at: http://www.aad.org/public/Publications/pamphlets/BlackSkin.htm . Accessed December 12, 2006.
Skin of color. American Academy of Dermatology website. Available at: http://www.aad.org/public/Publications/pamphlets/BlackSkin.htm . Accessed June 24, 2005.
What is a keloid? Skin Research Group, University of Miami website. Available at: http://dermatologyresearch.med.miami.edu/x20.xml . Accessed December 12, 2006.
What is a keloid? Skin Research Group, University of Miami website. Available at: http://dermatologyresearch.med.miami.edu/x20.xml . Accessed June 24, 2005.
Last reviewed January 2009 by Ross Zeltser, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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