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 surgery.
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 of 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 joint function.
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 biopsy.
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 cancer. Radiation 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 research studies.
- 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.