A keloid is a fleshy but firm raised area of skin that develops when scar tissue from a healing injury, usually 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 most common among African American, Asian, and Hispanic individuals. Keloids are not harmful or life-threatening.

Causes

For unknown reasons, the mechanisms that regulate scar tissue formation become uncontrolled. Proteins like collagen continue to multiply after the wound has been covered—a process that can continue for weeks or months. This is especially true for the following areas:

• Earlobes

• Knees

• Soles of the feet

• Shoulders

• Upper back

• Chest

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors 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

Symptoms

Keloids typically begin as a small lump at the site of a skin injury and gradually grow beyond the margins of the original wound, but do not penetrate below the surface. They can occur in any area of the body that undergoes repeated tension or motion.

Symptoms include:

• Pain

• Burning

• Itchiness

• Tenderness

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. You may be referred to a dermatologist or plastic surgeon that can confirm the diagnosis and assist in keloid removal. Tests may include a biopsy to rule out tumor formation or other hypertrophic skin disorders.

Treatment

In rare cases, some keloids dissolve spontaneously. However, in those at risk for keloid formation, it is common for a keloid to reappear after it has been removed, a disorder known as keloidosis. 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 reoccurrence

• Minimize scarring

Treatment options may vary and your doctor may recommend more than one depending on your condition. They include:

• Corticosteroid Injections

• • These are made directly into the skin lesion and repeated every 3-4 weeks for six months

• • Steroids relieve itching and slow down collagen formation, thus causing the keloid to atrophy (shrink)

• • This procedure may be combined with surgery to excise any remaining lesion

• Compression Dressings

• • Silicone gel sheeting is placed over the lesion and secured with tape or a bandage for at least 12 hours

• • This process is used to apply pressure to the keloid to flatten it

• • The dressing is reapplied every 7-10 days

• • This form of treatment may continue over a period of 3-12 months

• Surgery

• • Surgical excision alone is usually done to remove keloids that develop along the earlobes

• • Larger, more severe lesions may receive a combination of surgery followed by radiation therapy to control scar formation

• Cryosurgery

• • This method is used to freeze small, contained lesions

• • It may be combined with corticosteroid injections

• Radiation Therapy

• • Radiation therapy is highly successful, however limited due to the toxicities

• Interferon-alfa

• • Interferon-alfa injections may reduce recurrence rates postoperatively

• Intralesional Fluorouracil

• • Intralesional fluorouracil (5-FU) may be of benefit for keloids

Prevention

To help reduce your chances of forming a keloid, take the following steps:

• Avoid trauma to the skin

• Attend to cuts or abrasions immediately to minimize scarring

• Avoid elective cosmetic surgery

• Do not tattoo or pierce your ears or other areas of the body

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

References:

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Dermatologic Disorders. Chapter 125 Benign Tumors. 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.

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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 (R Coll Radiol). 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.

Newsome RE, Langston K, Wang A, Jansen D. Wound Healing, Keloids. eMedicine website. Available at: http://www.emedicine.com/plastic/topic404.htm Accessed June 24, 2005.

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.

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