Keloid Scar

1. Overview

A keloid scar is a type of raised scar that occurs where the skin has healed after an injury. Unlike typical scars, keloids grow much larger than the original wound, almost like the healing process doesn't know when to stop. They happen because the body produces too much collagen, a protein that helps heal wounds.

Anyone can get a keloid, but they are more common in people with darker skin tones, and there's often a genetic link – meaning if your family members get them, you might too. They most often appear in people between the ages of 10 and 30. It's important to know that keloids are not contagious; you can't catch them from someone else. While not usually harmful to your physical health, keloids can be a source of discomfort, itchiness, or self-consciousness, impacting how you feel about your appearance. We understand that dealing with any skin concern can be worrying, and we're here to help you understand more.

2. Symptoms

You might notice a keloid developing weeks or even months after an initial skin injury. Here’s what to look for:

• A raised, firm, and often shiny scar that grows beyond the original wound's boundaries.
• The scar may start as pink, red, or flesh-colored, and can darken over time, sometimes becoming darker than your surrounding skin.
• Itching is a very common symptom, and it can sometimes be quite intense.
• Tenderness or pain when the keloid is touched or pressed.
• The keloid may continue to grow slowly over months or even years.
• In some cases, if a keloid forms over a joint, it might restrict movement.
• The texture is often rubbery or firm to the touch.
• Keloids can develop after any type of skin injury, including cuts, burns, acne, piercings, tattoos, or even insect bites.

3. Diagnosis

Diagnosing a keloid is usually straightforward for a healthcare professional.

• Visual Examination: Most often, a doctor can diagnose a keloid simply by looking at the scar and asking about your medical history, including any previous injuries or family history of keloids.
• Biopsy (Rarely): In some cases, especially if there's any doubt or to rule out other skin conditions, your doctor might take a small sample of the scar tissue (a biopsy) to examine under a microscope. This is not usually necessary for typical keloids.

Management & Treatment

Finding the right approach for your keloid is a journey, and it’s one we can navigate together. Treating keloids can be challenging, and while they may not disappear completely, there are many ways to reduce their size, improve their texture, and ease symptoms like itching and pain. It's important to have patience, as it can take time to see results.

Over-the-Counter (OTC) & Home Care Strategies

For newer or less severe keloids, you can start with these gentle, at-home options:

• Silicone Sheets or Gels: These are a go-to first step. Silicone sheets are thin, self-adhesive pads that you place over the keloid. They work by hydrating the scar tissue and reducing collagen production. Consistent use over several months is key to seeing improvement.
• Pressure Dressings: Applying steady pressure to a healing wound or a new keloid can prevent it from growing. This can involve using special pressure earrings for earlobe keloids or custom-fitted garments for larger areas. It requires dedication, as they often need to be worn for many hours a day.

When Prescription Treatments May Be Needed

If over-the-counter options aren't providing enough relief, it's time to see a dermatologist. They can offer a range of treatments that are often used in combination for the best results:

• Corticosteroid Injections: This is the most common and effective treatment for keloids. A dermatologist injects a steroid solution directly into the scar tissue. This helps to break down the tough collagen fibers, flattening the keloid and reducing itching and redness. The injections are typically given every 4-6 weeks.
• Cryotherapy: This involves freezing the keloid with liquid nitrogen. The extreme cold helps to destroy the excess scar tissue from the inside out. It can be particularly effective for smaller keloids.
• Laser Therapy: A pulsed-dye laser can be used to reduce the redness in a keloid and help flatten it. It's a gentle option that is often combined with steroid injections for better results.
• Surgical Removal: While it might seem like a simple solution, surgically removing a keloid comes with a high risk of the keloid growing back, sometimes even larger than before. Because of this, surgery is almost always followed by other treatments, like steroid injections or radiation, to prevent recurrence.

Expected Timeline for Improvement

Patience is so important when treating keloids. With consistent treatment, you may start to see some flattening and feel less itching within a few months. However, it can take a year or more to achieve the best possible results.

What to Do if Treatments Aren't Working

Living with keloids can be frustrating, especially when treatments don't seem to work as quickly as you'd like. It's important to maintain an open dialogue with your dermatologist. If one approach isn't effective, they can suggest another or a combination of therapies. Your well-being is the top priority, and finding a solution that makes you feel more comfortable in your skin is a team effort.

4. Duration & Outlook

Keloids are generally considered a chronic condition, meaning they don't usually go away on their own without intervention.

• Timeline: Once a keloid forms, it tends to be permanent unless specific measures are taken to address it. Some may stop growing or even soften slightly over many years, but they rarely disappear completely.
• Outcomes: The main outcome is a persistent, raised scar. While they are benign (not cancerous), they can be a cosmetic concern or cause discomfort.
• Warning Signs for Complications: While rare, look out for signs of infection if the keloid is irritated or scratched open (increased redness, swelling, pus, warmth, fever). Also, very rapid growth or significant pain should prompt a visit to your doctor.

5. Prevention

While it's not always possible to prevent keloids, especially if you're prone to them, there are steps you can take to reduce your risk:

• Avoid unnecessary skin trauma: If you know you're prone to keloids, think carefully before getting elective surgeries, piercings (especially on earlobes or upper body), or tattoos.
• Proper wound care: If you do get a cut, burn, or surgical wound, take excellent care of it. Keep it clean and covered. Some doctors may recommend pressure dressings or silicone gel sheets on new wounds if you have a history of keloids.
• Treat acne promptly: Severe acne can lead to keloid scarring, so managing acne effectively can help prevent this.
• Inform your surgeon: If you need surgery, tell your surgeon that you are prone to keloids. They may be able to use special techniques to minimize scarring.

6. Causes & Triggers

Understanding what causes and triggers keloids can be helpful.

• Cause: Keloids are caused by an overproduction of collagen during the skin's healing process. Instead of stopping when the wound is filled, the body keeps making scar tissue, which then spreads beyond the original injury site. The exact reason why some people's bodies react this way isn't fully understood, but genetics play a significant role.
• Common Triggers: Any injury to the skin can trigger a keloid in susceptible individuals. This includes:
  • Surgical cuts
  • Acne spots and boils
  • Burns
  • Chickenpox scars
  • Ear piercings or other body piercings
  • Vaccination sites
  • Scratches
  • Tattoo sites
• Who is most likely to develop it?:
  • People with a family history of keloids.
  • Individuals with darker skin tones (e.g., African, Hispanic, or Asian descent) are significantly more prone.
  • People between the ages of 10 and 30.
• Risk Factors: The main risk factors are genetic predisposition, skin type, and age. Having a previous keloid also increases your risk of developing more.

7. When to see a doctor:

It's always a good idea to consult a healthcare professional if you have concerns about your skin. For keloids, consider seeing a doctor or dermatologist if:

• You notice a scar that is growing larger, especially beyond the boundaries of the original injury.
• The scar is painful, very itchy, or tender.
• The keloid is in a visible location and causing you distress or affecting your self-esteem.
• A keloid is restricting your movement (e.g., if it's over a joint).
• You are unsure if the growth is a keloid or something else.
• You have a family history of keloids and are concerned about a new scar.
• You notice any signs of infection, such as increased redness, warmth, swelling, or pus.

A dermatologist can confirm the diagnosis and discuss your concerns. Remember, getting professional advice is the best way to manage any skin condition, and we're here to empower you with information on that journey.

8. Frequently Asked Questions (FAQs):

• Q: Are keloids cancerous? A: No, keloids are benign, which means they are not cancerous and do not turn into cancer. They are an overgrowth of scar tissue.
• Q: Can keloids go away on their own? A: It's very rare for keloids to disappear completely on their own. They might soften or stop growing over time, but they usually remain visible without specific interventions.
• Q: If I have one keloid, will I get more? A: If you've developed one keloid, you are at a higher risk of developing others if your skin is injured again.
• Q: Why do some people get keloids and others don't? A: Genetics play a large role. People with a family history of keloids or those with darker skin tones are more predisposed to forming them due to differences in how their skin heals.
• Q: Can I prevent a keloid from forming after an injury? A: If you know you're prone to keloids, meticulous wound care is important. Discuss preventative options like silicone sheets or pressure garments with your doctor immediately after an injury or surgery.

References

• American Academy of Dermatology. (n.d.). Keloid scars: Diagnosis and treatment. Retrieved from https://www.aad.org/public/diseases/a-z/keloids-treatment
• Mayo Clinic. (2022, December 13). Keloid scar. Retrieved from https://www.mayoclinic.org/diseases-conditions/keloid-scar/diagnosis-treatment/drc-20520902
• Cleveland Clinic. (2023, July 18). Keloid Scar. Retrieved from https://my.clevelandclinic.org/health/diseases/keloid-scar