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Keloid Scars

A keloid scar is an abnormal proliferation of scar tissue that grows beyond the original boundary of a wound. Unlike normal scars that fade and flatten over time, keloids are "active" scars that continue to invade the surrounding healthy skin. They are benign (non-cancerous) but can be disfiguring, painful, and notoriously difficult to treat because cutting them out often triggers them to grow back larger. Management requires a specialized approach combining multiple medical therapies to suppress the overactive scar tissue.

Key Points

  • Keloids are firm, raised, smooth scars that extend beyond the original wound site.
  • They are most common on the earlobes, chest, shoulders, and upper back.
  • They are not dangerous but can cause significant pain, itching, and cosmetic distress.
  • Cutting a keloid out (surgery) without follow-up treatment has a recurrence rate of up to 50-100%.
  • Early treatment of active, red, itchy keloids yields the best results.

What is a keloid?

A keloid is a result of an aggressive healing response. When the skin is injured (by a cut, burn, piercing, or acne), the body produces collagen to repair the damage. In keloid-prone individuals, this collagen production does not shut off. The "glue" that holds the skin together keeps piling up, creating a hard, rubbery lump that grows uncontrolled.

Who gets keloids?

Keloids affect approximately 10-15% of the population. They are significantly more common in individuals with darker skin types (Fitzpatrick skin types IV-VI), including those of African, Asian, and Hispanic descent. They typically appear between the ages of 10 and 30 and are less common in young children or the elderly.

Contact Smooth Skin Clinic for a specialized scar management plan.

Clinical features

Keloid scars present as firm, rubbery, or hard nodules that project above the skin surface, often shiny and hairless in appearance. Unlike hypertrophic scars, which stay within the wound margins, keloids invade the adjacent normal skin in a "claw-like" fashion. They can range in colour from pink to flesh-coloured or dark brown. Patients frequently report that the scar is "active," causing sensations of sharp shooting pains, tenderness to the touch, and intense itching, particularly during warm weather or when the scar is growing.

 

1. Ear Lobe Keloid Commonly triggered by piercings. They appear as round, hard balls hanging from the earlobe or behind the ear.

 

2. Chest Keloid Often "butterfly" shaped, spreading outwards across the chest wall. These are frequently triggered by acne spots.

Diagnosis and differential diagnosis

Diagnosis is clinical, based on the scar's appearance and history of growth. Differential Diagnosis:

  • Hypertrophic Scar: A raised scar that stays within the original wound lines and often improves on its own.

  • Dermatofibroma: A hard, benign skin lump often caused by insect bites.

  • DFSP (Dermatofibrosarcoma Protuberans): A rare soft tissue tumour that can mimic a keloid; if a scar looks unusual or has no clear cause, a biopsy is essential.

Impact and complications

Physical: Large keloids can restrict movement if they form over a joint. Chest keloids can be painful when sleeping on the stomach or wearing tight clothing/seatbelts.

 

Psychological: Because they continue to grow and are often visible, keloids cause significant anxiety and self-consciousness. Many patients avoid swimming or wearing certain clothes to hide them.

Causes and triggers

    • Genetics: If your parents have keloids, you are at high risk.

    • Trauma: Any skin injury, including surgical cuts, vaccinations, burns, or tattoos.

    • Tension: Keloids love areas of high skin tension (e.g., the chest or shoulders).

    • Inflammation: Severe acne (cystic acne) on the chest and back is a leading cause of spontaneous keloids.

Treatment Options

  • Intralesional Corticosteroids Injections of high-strength steroid (Triamcinolone) directly into the scar to soften it and stop the itching. This is the mainstay of treatment.
  • Cryotherapy Freezing the scar from the inside out to destroy the blood vessels feeding it.
  • 5-Fluorouracil (5-FU) A chemotherapy agent mixed with steroid injections to halt cell growth in stubborn scars.
  • Surgical Excision Only performed in combination with post-operative radiation or steroid injections, as surgery alone almost guarantees the keloid will return bigger.

Expectations and Outcomes: The goal is to make the scar flat, pale, and asymptomatic (pain-free). While we can often flatten the scar completely, the texture of the skin may remain different from normal skin.

Frequently Asked Questions

Have questions about scheduling or what to expect? Here are answers to common inquiries to help you feel fully prepared.

We strongly advise against simple surgery. Cutting a keloid releases more growth factors, often causing it to grow back twice the size ("Rebound Effect"). If surgery is necessary, it must be paired with immediate steroid injections or radiation therapy.

Itching is a sign of "activity." It means the nerve endings are being stimulated by the growing collagen fibres. If your scar is itching, it is likely growing, and you should seek treatment (usually a steroid injection) to calm it down immediately.

If you or your immediate family have keloids, we generally recommend avoiding all non-essential piercings and tattoos, especially on the upper ear (cartilage) and chest, as these are high-risk zones.