Definition

A keloid is an extra growth of scar tissue over a skin wound. It grows beyond the margins of the skin wound. A keloid can vary in size from 1 to several inches. They are not harmful to general health.

Keloids can occur anywhere but they are more common on:

• Earlobes
• Shoulders
• Upper back
• Chest
• Back of scalp and neck

Causes

Scar tissue is a part of the normal healing process. With keloids, the scar tissue grows in an uncontrolled manner. The scar continues to grow even after the wound has been covered. The growth can continue for weeks or months.

Risk Factors

Keloids are more common in people with African American, Asian, or Hispanic ethnicity. They are also more likely to occur between 10-30 years old.

Factors that may increase your chance of keloids include:

• Deep skin wounds, such as those from infections, burns, or surgical scars
• Darkly pigmented skin
• Family history of keloids
• Elevated hormone levels (as with puberty or pregnancy)

Symptoms

Keloids often begin as small lumps at the site of a skin injury. They gradually grow beyond the edges of the wound.

For most, the scar is the only symptom. Some may have other symptoms such as:

• Pain
• Burning
• Itchiness
• Tenderness

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Diagnosis is often based on exam and history but you may also be referred to a skin specialist to confirm diagnosis.

Treatment

Some keloids may go away on their own, but this is rare. If the keloid is not bothersome, then it does not need to be treated.

A large or irritating keloid may be removed with surgery, lasers, or injections.

To prevent the regrowth of keloid after surgery, the doctor may recommend one or more of the following:

• Corticosteroid injections—Often given with surgery and repeated every 3-4 weeks for 6 months. Steroids can relieve itching and pain, slow scar formation, and cause some shrinking of the keloid in some people.
• Medication may be injected into the area or applied as a cream after the surgery.
• Silicone gel sheets—A special material creates a watertight seal over the scar for an extended period of time. The silicone creates a moist, ideal environment for the skin to heal while keeping out bacteria and dirt that may worsen scarring.
• Skin hydration (including topical moisturizer) and sunscreen
• Radiation therapy may be delivered after surgery. This therapy is limited as an option because it is toxic to healthy tissue.

Prevention

To help reduce your chances of forming a keloid:

• Avoid trauma to the skin.
• Care for cuts or scrapes right away.
• Avoid unnecessary cosmetic surgery.
• Do not tattoo or pierce your ears or other areas of the body.

American Society of Plastic Surgeons http://www.plasticsurgery.org

Health Canada www.hc-sc.gc.ca

Conejo-Mir JS, Corbi R, et al. Carbon dioxide laser ablation associated with interferon alfa-2b injections reduces the recurrence of keloids. J Am Acad Dermatol.1998; 39:1039.

Keloid. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated December 20, 2015. Accessed June 4, 2015.

Malaker K, Vijayraghavan K, et al. Retrospective analysis of treatment of unresectable keloids with primary radiation over 25 years. Clin Oncol. 2004;16:290.

Manca G, Pandolfi P, et al. Treatment of keloids and hypertrophic scars with bleomycin and electroporation. Plast Reconstr Surg. 2013;132(4):621e-630e.

O’Brien L, Jones DJ. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev. 2013;9:CD003826.

5/22/2014 DynaMed’s Systematic Literature Surveillance
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Shaffer JJ, Taylor SC, et al. Keloidal scars: A review with a critical look at therapeutic options. J Am Acad Dermatol. 2002;46:S63-S97.