Everything you need to know about Keloids - Causes, Diagnosis and Treatment

Dr Karoon Agrawal

If its the first time you’ve developed a keloid, you probably have a ton of questions and you are scrambling through the web to find the type of keloid you have and to understand the best possible treatment options available. 

This is the most comprehensive blog you’ll find on the web about keloid scars, it will resolve all your queries and will help you make the right decision on whether to live with the keloid or to get rid of it. 

When a wound heals, it leaves a scar. A keloid scar is one that becomes thick, lumpy and raised. Keloids are typically larger than the original wound.

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What are keloid scars?

A keloid scar is an enlarged, raised scar that can be pink, red, skin-coloured or darker than the surrounding skin.

They can develop after very minor skin damage, such as an acne spot or a piercing, and spread beyond the original area of skin damage. 

It can occur spontaneously also in some cases. 

Do keloid scars hurt?

Yes, it does hurt. Most often it causes

  • pain
  • itching
  • burning, and is tender.

It may limit the joint movements if located over or across a joint.

What causes keloid scars?

Experts do not fully understand what causes keloid scars, but they happen when there’s overproduction of collagen (the skin’s protein).

They’re not contagious or cancerous.

If you have had a keloid scar before, you’re more likely to get another.

Who gets keloid scars?

Men and women worldwide develop these raised scars. Some people, however, have a higher risk of developing a keloid when they scar. You’re more likely to develop a keloid if you have one or more of the following:

  • Asian, African or Hispanic descent. The keloid is the most common skin condition among ethnic Chinese in Asia. In the United States, keloids are more common in African Americans and Hispanic Americans than whites.
  • Family history of keloids. About 1/3 of people who get keloids have a first-degree blood relative (mother, father, sister, brother, or child) who gets keloids. This family trait is most common in people of African or Asian descent.
  • Between 10 and 30 years of age. This is the peak time to develop keloids. Most people begin seeing keloids in their 20s. Although keloids can develop earlier or later, children and the elderly rarely get a keloid when they scar.

Some people are more likely to get keloids. Young adults who have dark skin are more likely to develop a keloid.  

Can you prevent keloid scars?

You cannot completely prevent keloid scars, but you can avoid any deliberate cuts or breaks in the skin, such as tattoos or piercings, including on the earlobes. 

Treating acne will reduce the likelihood of acne scars appearing.

Avoid minor skin surgery to areas more prone to keloid scarring (the upper chest, back and upper arms) if possible.

Treatments for keloid scars

Keloid scar treatments include the following. One or a combination of approaches might be best for your situation. Even after successful flattening or removal, keloids can grow back, sometimes bigger than before. Or you may develop new ones.

  • Wound care. For newer keloids, the first treatment option might be compression dressings made from stretchy fabric or other materials. This method is also used to avoid keloids. The goal is to reduce or prevent a scar by putting pressure on the wound as it heals. Such dressings need to be worn for 12 to 24 hours a day for 4 to 6 months to be effective. This method can be very uncomfortable for some.
  • Corticosteroid cream. Applying a prescription strength corticosteroid cream can help ease itchiness.
  • Injected medicine. If you have a smaller keloid, your doctor might try reducing its thickness by injecting it with cortisone or other steroids. You’ll likely need monthly injections for up to six months before seeing the scar flatten. Possible side effects of corticosteroid injections are skin thinning, spider veins and a permanent change in skin color (hypopigmentation or hyperpigmentation).
  • Freezing the scar. Small keloids might be reduced or removed by freezing them with liquid nitrogen (cryotherapy). Repeat treatments might be needed. Possible side effects of cryotherapy are blistering, pain and loss of skin color (hypopigmentation). This is not a popular choice of treatment.
  • Laser treatment. Larger keloids can be flattened by pulsed-dye laser sessions. This method has also been useful in easing itchiness and causing keloids to fade. Pulsed-dye laser therapy is delivered over several sessions with 4 to 8 weeks between sessions. Your doctor might recommend combining laser therapy with cortisone injections. Possible side effects, which are more common in people with darker skin, include hypopigmentation or hyperpigmentation, blistering and crusting.
  • Radiation therapy. Low-level X-ray radiation alone or after surgical removal of a keloid can help shrink or minimize the scar tissue. Repeat treatments might be needed. Possible side effects of radiation therapy are skin complications and, in the long term, cancer. Hence this is not a popular choice for treatment of a keloid.
  • Surgical removal. If your keloid hasn’t responded to other therapies, your doctor might recommend removing it with surgery in combination with other methods. Surgery alone has a recurrence rate of 45% to 100%.

Try these keloid self-care tips:

  • Care for your wound as directed. Wound care can be time-consuming, and compression dressings can be uncomfortable. Try to stick with the routine recommended by your doctor, as these steps are important to keloid prevention.
  • Apply a corticosteroid cream. This type of nonprescription cream can help ease itchiness.
  • Apply silicone gel. Applying nonprescription silicone gel can help ease itchiness.
  • Protect the area from re-injury. Avoid irritating the keloid with clothing or other types of friction or injury.
  • Protect your skin from the sun. Sun exposure might change the color of your keloid, making it more noticeable. That change might be permanent. Before going outside, protect your skin by covering the keloid or by liberally applying sunscreen.

How Do I Get Rid of a Keloid on My Ear?

Keloids are common after ear piercing and can form on both the lobes and pinna.

Keloids from piercings

Getting your ears pierced might not feel like a serious injury, but that’s sometimes how your body sees it.

As wounds heal, fibrous scar tissue starts to replace old skin tissue. Sometimes your body makes too much scar tissue, leading to keloids. This extra tissue starts to spread out from the original wound, causing a bump or small mass that’s larger than the original piercing.

On the ear, keloids typically begin as small round bumps around the piercing site. Sometimes they develop quickly, but usually they appear several months after you pierce your ear. Your keloid may continue growing slowly for the next few months.

About Dr. Karoon Agrawal

Specializing in a wide range of Plastic Reconstructive and Aesthetic Surgery procedures, Dr. Karoon Agrawal has been delivering unparalleled results for the last 40 years. His innovations in this field have been lauded by both patients and peers alike for their effectiveness and industry minimum complication rates leading him to be awarded the lifetime achievement award for his contribution to the field of Plastic Surgery in India. In addition to being the Director Professor and Head of the Plastic Surgery Departments of Safdarjung Hospital in Delhi and JIPMER Hospital in Pondicherry, he has conducted workshops and lectures to train Plastic Surgeons around the world. He has also been the advisor to the Govt. of India and is on the medical advisory board of Smile Train, the largest global non-profit organization for cleft surgeries based out of the USA. In addition, he has published the world’s first six volume Plastic Surgery Textbook from a developing country.

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