What Are Keloids?
Keloids, also known as keloid scars, raised scars, or hypertrophic scars, are a type of abnormal scarring that extends outside and beyond the original wound. In general, keloids are an exaggerated body response when trying to heal an injury, which leads to the formation of raised fibrous tissue which is hard and poorly defined.
This type of scarring is very common, and often causes discomfort and rejection. Since they’re always raised and tend to have a different coloration than the surrounding skin, people can experience distress, anxiety, and depression as a result (especially if they’re in a noticeable area). We’ll tell you what we know about them in this article.
Characteristics of keloids
Researchers classify keloids as excessive pathological scarring, with the scar tissue extending beyond the initial edges of the wound. This process is progressive, so it can take months for the scar to reach its final shape. They can cause pain, itching, and burning, and are usually lighter or darker in tone than the surrounding skin.
Keloids are also characterized by being thick, hard, and with an irregular texture. Rubbing or friction with clothing or objects worsens the itching symptoms, although these usually disappear when the scar tissue stops extending. As a general rule, this occurs around 12 months after the process starting.
By themselves, they don’t cause any health problems, although they’re perceived as aesthetic discomfort. For this reason, the evidence indicates that their development has an impact on people’s quality of life, and it does so in relation to how noticeable the affected area is.
Keloids don’t go away on their own, and can show great resistance to treatment. In these contexts the emotional consequences are intensified.
Causes of keloids
As experts rightly point out, dark-skinned people of African, Asian, and Hispanic descent have higher rates of developing keloids compared to Caucasians. In these groups, the incidence can be up to 16%, with higher rates during puberty and pregnancy. Their formation is due to a combination of genetic and environmental factors.
Some rare genetic disorders increase the chance of developing keloids, such as Rubinstein-Taybi syndrome and Goeminne syndrome. No specific genes have been identified so far, but a family history of abnormal scarring increases the chances of them developing.
They’re also normally restricted to specific areas, and are most common on the shoulders, upper back, back of the neck, and sternum.
On the contrary, their development on the palms, soles, eyelids, and genitals is very rare. Although we’ve mentioned that they appear due to the healing process of a wound, they can also appear independently of it.
Indeed, keloids can form after infectious processes or superficial traumas. They’re also more common when an object enters the body, so this explains why they often appear on the earlobe and other sections of the ear after ear piercing. Hormonal changes are also behind it, which is why they frequently occur during pregnancy and puberty/adolescence.
Keloids don’t require treatment, although people can request it for aesthetic reasons. It’s also considered a viable option when scar tissue restricts mobility, such as when it develops at the intersection of a joint.
There’s no gold standard to deal with them, so the choice is made by the specialist based on the severity of the injury, and the patient’s age and preferences.
It’s often good to consider several options, because many keloids are difficult to remove. They don’t always disappear completely, so, in some contexts, they’ll be minimized. These are the main options according to the experts:
- Occlusive dressings: These include silicone gel sheets. They act through hydration and occlusion of the wound bed, which prevents tissue formation. It’s a viable option when detecting the first signs of scar malformation.
- Compression therapy: This is mainly used to treat keloids in the ears. There are many types, including elastic bandages, custom ear molds, earrings, and magnets.
- Intralesional steroids: These are a preferred option for many specialists, although they’re considered a complementary therapy. Triamcinolone is the most used in these cases, and is injected in concentrations ranging from 2.5 to 20 milligrams for the facial area and between 20 to 40 milligrams for non-facial areas.
- Topical imiquimod cream: Although primarily used to treat basal cell carcinoma and HPV warts, it has also been shown to be effective in removing keloids.
- Topical Mitomycin C: Often used to prevent recurrences or as a preventative method after surgery or injury. It’s less effective when treating already-developed scars.
- 5-fluorouracil (5-FU) intralesional and topical: This is used to treat already-developed keloids, as long as they aren’t more than two years old (the effectiveness is greatly reduced in these cases). Therapies of this type can take at least six months.
- Interferons: Although it isn’t used as much as the other options, it’s considered an option when progress hasn’t been achieved by other means. Therapy usually lasts between three and ten weeks.
- Bleomycin: This is also used for hypertrophic scars and shows a very low recurrence rate. Not all patients respond in the same way, so the patient shouldn’t have high expectations.
- Surgical techniques: This type of scarring can also be addressed through surgical techniques. This isn’t the first line of action, due to its high recurrence rates.
Other available options are cryotherapy, radiation therapy, pulsed dye laser (PDL), ablative laser, laser-assisted drug delivery (LADD), and platelet-rich plasma (PRP) application. Keloids are likely to recur so patients should be aware of this.
Since the underlying mechanisms aren’t well understood, there isn’t much you can do to completely prevent the formation of these abnormal scars. However, some habits can reduce the risk of manifesting them, especially if you’re within the risk groups. We’ll leave you with some advice from the American Academy of Dermatology (AAD):
- Pay attention to ear piercings for abnormalities. If you detect any, remove the earring and replace it with a pressure one.
- Evaluate how the skin reacts to small perforations, tattoos and cosmetic surgery. If you detect any abnormalities, the use of a pressure garment can prevent the keloid from developing.
- Inform the surgeon if you have had keloids in the past.
- Tend to a wound immediately after an injury in order to prevent infection and poor healing.
- Protect wounds from direct sunlight.
- Use sheets or silicone gel to finish healing the scars that have resulted from an injury.
Beyond this, you can’t do any more than to try to prevent their development. Pressing on the affected area when the keloid is emerging can prevent abnormal healing. Keep in mind that many of them can protrude several millimeters and even centimeters from the skin, so acting in time is vital, bearing in mind that we cannot predict how they will develop.
If you can see them forming, seek medical assistance. Specifically, see a qualified dermatologist.
If you’re part of a risk group, avoid activities that could cause surface skin injuries, and never carry out any type of surgery for aesthetic reasons. Although most scars don’t usually grow that much, the truth is that many people regard them as aesthetically unpleasant.It might interest you...
- Alster, T. S., & Tanzi, E. L. Hypertrophic scars and keloids. American journal of clinical dermatology. 2003; 4(4): 235-243.
- Betarbet, U., & Blalock, T. W. (2020). Keloids: A review of etiology, prevention, and treatment. The Journal of Clinical and Aesthetic Dermatology. 2020; 13(2): 33.
- Bock, O., Schmid-Ott, G., Malewski, P., & Mrowietz, U. Quality of life of patients with keloid and hypertrophic scarring. Archives of dermatological research. 2006; 297(10): 433-438.
- McGinty, S., & Siddiqui, W. J. Keloid. StatPearls [internet]. 2020.