Keloids

Definition

Keloids are the excess growth of scar tissue at the site of a healed skin injury.

Alternative Names

Hypertrophic scar; Keloid scar; Scar - hypertrophic

Causes, incidence, and risk factors

Keloids occur from such skin injuries as:

• Acne
• Burns
• Chickenpox
• Ear piercing
• Minor scratches
• Surgical cuts
• Traumatic wounds
• Vaccination sites

They are more common in people ages 10 to 20, and in African Americans, Asians, and Hispanics. Keloids often run in families. Keloidosis is a term used when many or repeated keloids occur.

Symptoms

A skin lesion that is:

• Flesh-colored, red, or pink
• Located over the site of a wound or injury
• Lumpy (nodular) or ridged

The lesion may itch while it is forming and growing.

Signs and tests

Diagnosis is based on the appearance of the skin or scar. A skin biopsy may be needed to rule out other skin growths (tumors).

Treatment

Keloids often do not need treatment. They may be reduced in size by:

• Corticosteroid injections
• Freezing (cryotherapy)
• Laser treatments
• Radiation
• Surgical removal

Support Groups

Expectations (prognosis)

Keloids usually are not medically dangerous, but they may affect the appearance. In some cases, they may become smaller, flatter, and less noticeable over a period of several years.

Exposure to the sun during the first year after the keloid forms will cause the keloid to tan darker than the skin around it. This dark color may be permanent.

Removing the keloid may not be permanent. Surgical removal may cause a larger keloid scar.

Complications

• Cosmetic changes that affect the appearance
• Discomfort, tenderness of the keloid
• Irritation from rubbing on clothing or other forms of friction
• Limited mobility (if the keloids are extensive)
• Psychological distress if the keloid is large or disfiguring
• Return of the keloid

Calling your health care provider

Call your health care provider if:

• You develop keloids and want to have them removed or reduced
• You develop new symptoms

Prevention

You can prevent discoloration from sun exposure by covering the forming keloid with a patch or Band-Aid, and by using sunblock when spending time in the sun. Continue these extra protection measures for at least 6 months after injury or surgery for an adult, or up to 18 months for a child.

Imiquimod cream has recently been used to prevent keloids from forming after surgery, or to prevent keloids from returning after surgery to remove them.

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References

Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. Am Fam Physician. 2009;80(3):253-260

Habif TP. Benign skin tumors. In: Habif TP, ed. Clinical Dermatology. 5th ed. St. Louis, Mo: Mosby Elsevier; 2009:chap 20.