Definition and Overview

A keloid is a skin condition resulting from an abnormal or excessive growth of scar tissue after a deep wound or injury has healed. It is a dermal fibrotic lesion without the potential to be malignant. Scar tissue, also called fibrous tissue, grows to repair and regenerate the skin after an injury. In some cases, however, the scar tissue grows excessively, leading to the formation of keloids. Studies show that this occurs when the repair mechanism of the body loses control, rendering the wound healing process abnormal.

A keloid grows a lot bigger than the original scar or wound. It is sometimes confused with hypertrophic scars, with the main difference being hypertrophic scars’ ability to disappear more easily over time, whereas keloids tend to stay for many years. However, both skin conditions are caused by the excessive growth of tissue that the body releases during tissue regeneration.

Keloids usually form within one year after the wound first appeared. Although they can appear anywhere on the body, they are more common in areas where tension mostly occurs such as the upper chest, shoulders, and anterior necks. They also typically appear when wounds are located in areas that cross skin tension lines. Although they do not have any dangerous health risks, keloids typically cause cosmetic concerns.

Cause of Condition

Keloids commonly affect people aged 10 to 20 and based on research, up to 15% of wounds lead to keloids. It is known to be a hereditary disease, which means that it runs in families. African Americans, Asians, and Hispanics face higher occurrence rates of keloids because of their highly pigmented skin. They are 15 times more likely to experience the condition than people with less pigmented skin.

Some types of wounds also have a greater tendency to transform into keloids, including the following:

  • Acne
  • Burns
  • Chicken pox
  • Scratches
  • Ear piercing
  • Cuts made in surgery
  • Vaccination marks

Key Symptoms

Below are signs of keloids:

  • Flesh-coloured, pink, or red in colour
  • Lumpy (nodular) or ridged
  • Itchy
  • Tender
  • Irritable due to friction
  • Continues to grow larger over time
  • Becomes darker in colour than the surrounding skin due to sun exposure

Itchy keloids indicate that the keloid is not harmful in any way. The main concern about keloids is mostly cosmetic, especially if it appears on a visible area such on the face.

Who to See and Types of Treatments Available

Keloids do not pose any serious medical dangers and do not usually require medical attention. However, if you’re bothered by it and if it continues to grow in size that may be considered problematic, consulting a medical professional is recommended.

The process of treating keloids begins with a skin biopsy to determine whether or not the lump is a tumour. In the field of medicine, testing and assessing any lump on the body is a standard procedure before initiating any treatment to ensure that the lump is not cancerous.

It is important to remember that some of the known treatments for the condition cause the keloids to expand, making them appear even bigger. Keloids are formed in the process of healing scars; so removing them may cause the scar tissue to attempt to repair itself again. Thus, there is a chance that it may once again grow excessively and form another keloid.

Despite this risk, there are still over-the-counter medications as well as treatment procedures available for the removal of keloids. Some of the most common are the following:

  • Freezing or cryotherapy - Cryotherapy makes use of liquid nitrogen to intentionally cause cell damage. Its adverse effects are depigmentaiton and some pain during the procedure. Its recurrence rate ranges from 61 to 74%.

  • Laser treatment - The use of laser has some advantages because it is precise and does not cause excessive inflammation. Laser therapy has different modes: flash lamp pulse-dyed laser, carbon dioxide laser, argon laser, and Nd:YAG laser. These types of lasers function in different ways to eliminate keloids. While the Nd:YAG laser stops the production of collagen, both carbon dioxide laser and argon laser work by shrinking the collagen using laser heat. The pulse-dyed laser, on the other hand, initiates microvascular thrombosis. These procedures are effective on some level, but all have the recurrence rate of 90%.

  • Surgical removal or excisional surgery - Surgical removal has a recurrence rate that ranges from 45 to 100%. Combining surgery with other treatments such as corticosteroid injection, steroid injection, x-ray therapy, and radiation can improve the results and can lessen the possibility of the keloid recurring.

  • The use of silicone gel or patches

  • Corticosteroid injection to reduce inflammation

  • Radiation to shrink the keloid

  • The use of moisturizing oils to soften the tissues

Like any treatment procedure, the above options can have adverse effects. For instance, corticosteroid injections may cause atrophy of the skin, hypopigmentation, telangiectasia, necrosis ulceration, and appearance of white flecks in the scar. Using the lowest possible dose of injection can prevent these effects.

Several types of medication are also helpful in eliminating keloids. Some of the medicinal treatments for keloids are the following:

  • Flurandrenolide tape (Cordran)
  • Bleomycin
  • Tacrolimus
  • Methotrexate
  • Pentoxifylline (Trental)
  • Colchicine

Just like with any other condition, prevention is still better than cure. The formation of keloids can be prevented through proper care. When you notice that a keloid is about to form on the area where you have been wounded, an effective way to prevent it is to cover it with a Band-Aid or a patch. This must be done continuously for six months after the injury if you are an adult, and 18 months for children.

References:

  • Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. Am Fam Physician. 2009;80(3):253-260
  • Romanelli R, Dini V, Miteva M, et al. Dermal Hypertrophies. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds.Dermatology. 3rd ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 98.
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