Coping with Keloids
Keloids are lumps of fibrous tissue that can develop at the site of an injury
to the skin, such as a burn or a surgical incision. They may be triggered
by severe acne or something as trivial as ear-piercing.
They are seen most commonly on the shoulders, upper back
and chest, but they can occur anywhere. When a keloid is associated with a skin
incision or injury, the keloid scar tissue continues to grow for a time after
the original wound has closed, becoming progressively larger and more visible.
They generally occur between 10 and 30 years of age and affect both sexes
equally, although they may be more common among young women with pierced ears.
They also may occur over the breastbone in people who have had open heart
Keloids are really just an exaggeration of the normal healing process which
results in scar formation after an injury.
After a laceration, for instance, is a sequence of events in which the breach
in the skin is filled. Initially a blood clot forms in the wound, and then
actively dividing cells and blood vessels grow into the gap. The healing
process is then completed by the laying down of tough fibrous tissue in the form
of a scar. A keloid develops when this fibrous tissue is laid down in
excess, resulting in a raised, lumpy area of scar-like tissue.
Some people seem to have a particular tendency to develop keloids . It is thought that keloids
are the result
an abnormality in the local hormonal or enzyme mechanisms which determine how
much tissue formation is appropriate.
In the early stages, a keloid appears as a soft, pink raised area over the
site of a previous wound. In time, it becomes whiter and firmer, and often
forms claw-like projections into the surrounding skin. On the earlobe, a keloid may become a pendulous mass of tissue.
As keloids are almost benign, do not spread or bleed, and are rarely painful,
treatment is not usually necessary, and medical opinion seems to be in favour of
leaving well alone. But remember that it is extremely important to show
any lump on the skin, however small, to your doctor in case it is a sign of a
more serious condition.
They are characteristically shiny, smooth and rounded skin
elevations that may be pink, purple or brown. They can be doughy or firm and
rubbery to the touch, and they often feel itchy, tender or uncomfortable. They
may be unsightly. A large keloid in the skin over a joint may interfere with
A physician diagnoses a keloid on the basis of its appearance
and a history of tissue injury, often surgery, acne or body piercing. In rare
cases, the doctor may remove a small piece of the skin to examine under a
microscope. This is called a
Over the course of several years, even without treatment, some keloids soften
and flatten out of their own accord. But treatment may be required if the keloid is unsightly and causes embarrassment.
Dressings — Moist wound coverings made of
silicone gel sheets have been shown in studies to reduce keloid prominence
over time. This treatment is safe and painless.
Corticosteroid injections — A great many keloids are successfully removed by injecting
them with a
steroid compound. Injections with triamcinolone
acetonide or another corticosteroid medicine typically are repeated at
intervals of four to six weeks. This treatment may reduce keloid size and
irritation, but injections are uncomfortable.
Cryosurgery — Smaller keloids can be frozen off by means of an
extremely cold probe. This freezing treatment
with liquid nitrogen is repeated every 20 to 30 days. It can cause a side
effect of lightening the skin color, which limits this treatment's usefulness.
Compression — This involves using a bandage or
tape to apply continuous pressure 24 hours a day for a period of six to 12
months. Such compression can provide a thinning effect on the skin.
Radiation therapy — This therapy is
controversial because radiation increases the risk of
treatments may reduce scar formation if they are used soon after a surgery,
during the time a surgical wound is healing.
Laser therapy — This is an alternative to conventional surgery for
keloid removal. There is no good evidence that keloids are less likely to
recur after laser therapy than after regular surgery.
Experimental treatments — On treatment that is showing promise is
injecting keloid scars with medicines that were developed to treat autoimmune
illnesses or cancers. Treatments with these medicines (various types of
interferon and the chemotherapy agents 5-fluorouracil and bleomycin) will need
to be evaluated further before they are appropriate for use outside of
Removal with conventional surgery - Where such measures are unsuccessful, or where the keloid is very large, surgical removal may be necessary. The problem with
surgery, however, is that the new scar may result in the formation of a
keloid, but this can usually be avoid by post-operative X-ray treatment.
How can keloids be prevented?
Although preventing keloids is better than treating them, this is, obviously,
not always possible. When injury or bad luck produces one, initiating therapy
soon with cortisone injections can make the final outcome more satisfactory.