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Medical Dermatology Conditions

Keloids

Keloids are enlarged scars that form from fibrous tissue. When the skin is cut, torn, or broken by injuries, the resulting wound is repaired and protected by a fibrous tissue called scar tissue. It is the body’s natural method of healing injured skin. However, in some cases, scar tissues progress with extra growth which is smooth and hard. These abnormal scar formations are called keloids. These are firm, pink, or purple bumps that rise quite abruptly above the rest of the skin and which can be itchy and irritating. They are commonly referred to as “scars that do not know when to stop” since they tend to enlarge progressively at the site of injury and can be much larger than the original wound. Keloids can occur on any part of the body but are more common on the shoulders, chest, back, ears, and cheeks.

Causes

Since they form from wounds, skin injuries that can contribute to its formation include:

  • Acne scars
  • Burns
  • Scars from diseases such as chickenpox scars
  • Piercings
  • Tattoos
  • Scratches
  • Insect bites
  • Surgical incision sites
  • Vaccination sites

Despite a list of skin injuries that could lead to keloids, experts are not yet able to pinpoint the exact underlying cause of their formation. Changes in the cellular signals that control rapid reproduction and inflammation are involved; however, attempts at explaining what triggers these changes have so far been inconclusive.

Research reveals that an estimated 10 percent of people experience scarring1. Keloids can occur in all skin types, but those who have a darker skin tone (including African, Hispanic, and Asian ethnic groups) are at greater risk – in fact, they are up to 15 times more likely to develop keloids according to some studies2. Keloids equally affect women and men and can occur at any age. Those under 30 years old are at a higher risk; while it less common in children and in the elderly. Genetic factors may also contribute to keloid development.

With this condition scarring becomes much more frequent, occurring even after minor injuries. Decorative piercing, for instance, is one of the main triggers of keloid scarring at present. However, as the underlying causes are not yet understood, it is impossible to predict whether skin injury caused by piercing will lead to keloid formation or not.

Symptoms

From the time of the occurrence of the injury, it may take weeks or even months for keloids to develop fully. Once developed, unlike scars, keloids do not regress over time. They are not life-threatening but can be aesthetically unpleasant. While there is no guaranteed treatment, recognizing early symptoms may help with managing the condition. Symptoms can be observed at the site of skin injury and can include:

  • A raised, shiny, dome-shaped lump
  • Pink to a red localized area
  • Itchy and irritable skin
  • The area is tender or even painful to the touch
  • The scar continues to grow larger over time

Severity

Keloids are not life-threatening and cases of complications are rare. However, they may cause psychological distress, depending on the appearance and location. Keloids also tend to grow larger and may become more difficult to treat. Do not attempt to cut the keloid, since it might result in infections or lead to an even larger keloid developing. Seek treatments if the keloids become larger and begin to become a bother, such as interfering with daily activities. Keloids can occasionally become cancerous, but cases are very rare.

Treatments

Although it is unclear if the early treatment helps slow keloid growth, it is established that larger keloids are more difficult to treat so seeking the doctor’s advice at the onset is recommended. No single treatment is guaranteed to work for all occurrences and treatment can be complex and difficult in some cases. Methods of managing keloids include:

  • Corticosteroid injections. These are safe but moderately painful and help by flattening the keloids, making them look better. However, they may leave a mark that feels different from the surrounding skin.
  • This involves cutting off the keloid, but the procedure is risky. since it may lead in some cases to the development of a larger keloid. Post-surgery treatment such as injecting steroids and applying compressions for several months using a specialized pressure device can help improve the chances of success of the surgery.
  • A pulse-dye laser is a safe and non-painful treatment used in flattening the keloids and making them less red. This further results in a smoother and more toned appearance. However, there is a risk of causing increased scarring and redness, making the keloids worse.
  • This involves covering the affected area with a sheet of silicone gel. This is done continuously for months with variable results.
  • A method of flattening the keloids by freezing them with liquid nitrogen. Some may experience severe pain during the procedure, but in most cases the treatment is tolerable.
  • These are proteins produced by the immune system that help fight off bacteria and viruses. Studies reveal that injecting interferon can reduce the size of the keloids; however, it is unclear if the effects are long-lasting.
  • Special earrings. These utilize pressure that causes the keloids on the earlobe to shrink significantly. These earrings must be used carefully and under specialized guidance.
  • Fluorouracil and bleomycin. These are chemotherapeutic agents, also called anti-cancer agents, that can be injected to treat keloids. They may be injected alone or along with steroids.
  • Prescription medicine commonly used for acne and aging. Applying it to the affected area can help reduce the size and appearance of keloids by speeding up the skin’s natural cell turnover.
  • Imiquimod cream. This cream is normally used to treat a variety of skin lesions and is proven to work well on the skin after undergoing surgical removal of the keloid. Studies also reveal that it reduces the chances of a keloid developing again.
  • Radiation therapy is reported to be safe and effective in treating keloids. It is given after surgically removing the keloid and has shown promising results with a high rate of cure or improvement.

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