(Keloid Scar; Dermal Fibrotic Lesion)
DefinitionA 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 one to several inches. They are not harmful to general health.Keloids can occur anywhere but they are more common on:
- Upper back
- Back of scalp and neck
CausesScar 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 FactorsKeloids 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
- Scars from acne , vaccinations, or chickenpox
- Family history
|Normal Surgical Scar|
|Ideally the scar tissue would stop developing at this point.|
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SymptomsKeloids 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:
DiagnosisYour doctor will ask 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.Your doctor may order a biopsy to rule out other skin conditions or tumors.
TreatmentSome 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. To prevent the regrowth of keloid after surgery the doctor may recommend one 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 the scar formation, and cause some shrinking of the keloid in some people.
- Radiation therapy may be delivered after surgery. This therapy is limited as an option because it is toxic to healthy tissue.
- 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.
PreventionTo 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 Academy of Dermatology
American Society of Plastic Surgeons
Canadian Dermatology Association
Scar revision. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/Reconstructive-Procedures/Scar-Revision.html. Accessed May 22, 2014.
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 3, 2013. Accessed May 22, 2014.
Malaker K, Vijayraghavan K, et al. Retrospective analysis of treatment of unresectable keloids with primary radiation over 25 years. Clin Oncol. 2004;16:290.
5/22/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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.
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.
- Reviewer: Michael Woods, MD
- Review Date: 05/2014
- Update Date: 05/22/2014
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