Keloid
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Keloid

(Keloid Scar; Dermal Fibrotic Lesion; Hypertrophic Scar)

Pronounced: KEE-loyd

En Español (Spanish Version)

Definition

A keloid is a fleshy but firm raised area of skin that develops when scar tissue from a healing injury, usually a deep skin wound, develops beyond the affected area. This results in a growth that can vary in size from one to several inches. Keloids are most common among African American, Asian, and Hispanic individuals. Keloids are not harmful to general health or life-threatening.

Causes

For unknown reasons, the mechanisms that regulate scar tissue formation become uncontrolled. Proteins like collagen continue to multiply after the wound has been covered—a process that can continue for weeks or months. This is especially true for the following areas:

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

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

  • African American, Asian, or Hispanic ethnicity
  • Between 10-30 years old
  • Deep skin wounds, such as those from burns or surgical scars
  • Scars from acne , vaccinations, or chickenpox
  • Family history

Normal Surgical Scar

Post-operative scar

Ideally the scar tissue would stop developing at this point. With keloids, the scar tissue will grow beyond the borders of the original scar.

© 2008 Nucleus Medical Art, Inc.

Symptoms

Keloids typically begin as small lumps at the site of a skin injury and gradually grow beyond the margins of the original wound, but do not penetrate below the surface. They can occur in any area of the body that undergoes repeated tension or motion.

Symptoms include:

  • Pain
  • Burning
  • Itchiness
  • Tenderness

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. You may be referred to a dermatologist or plastic surgeon who can confirm the diagnosis and assist in keloid removal. Tests may include a biopsy to rule out tumor formation or other hypertrophic skin disorders.

Treatment

In very rare cases, some keloids dissolve spontaneously. However, in those at risk for keloid formation, it is common for a keloid to reappear after it has been removed. The main goals of keloid treatment are to:

  • Remove the keloid to allow normal healing
  • Stop the discomfort caused by pain, burning, itchiness, or tenderness
  • Avoid recurrence
  • Minimize scarring

Treatment options may vary, and your doctor may recommend more than one depending on your condition.

Corticosteroid Injections

These are made directly into the skin lesion and repeated every 3-4 weeks for six months. Steroids relieve itching and pain, and slow down collagen formation, causing the keloid to shrink. This procedure may be combined with surgery to excise any remaining lesion.

Compression Dressings

Silicone gel sheeting is placed over the lesion and secured with tape or a bandage for at least 12 hours. This process is used to apply pressure to the keloid to flatten it. The dressing is reapplied every 7-10 days, and the treatment may continue over a period of 3-12 months.

Surgery

Surgical excision is usually done in combination with corticosteroid injections. In the most severe cases, radiation therapy is used to prevent recurrence.

Cryosurgery

This method is used to freeze small, contained lesions. Cryosurgery may done in combination with corticosteroid injections.

Radiation Therapy

Radiation therapy is highly successful, but limited due to the toxicities.

Interferon-alfa

Interferon-alfa injections may reduce recurrence rates after surgery.

Intralesional Fluorouracil

Intralesional fluorouracil (5-FU) may be of benefit for keloids.

Prevention

To help reduce your chances of forming a keloid, take the following steps:

  • Avoid trauma to the skin.
  • Attend to cuts or abrasions immediately to minimize scarring.
  • Avoid elective cosmetic surgery.
  • Do not tattoo or pierce your ears or other areas of the body.

RESOURCES:

American Academy of Dermatology
http://www.aad.org

American Osteopathic College of Dermatology
http://www.aocd.org

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

CANADIAN RESOURCES

Canadian Dermatology Association
http://www.dermatology.ca/english/

Dermatologists.ca
http://www.dermatologists.ca/index.html

References:

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

Dermatologic disorders: keloid. The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.com/mrkshared/mmanual/section10/chapter125/125k.jsp . Accessed December 12, 2006.

Dermatologic disorders: keloid. The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.com/mrkshared/mmanual/section10/chapter125/125k.jsp . Accessed June 24, 2005.

Everyday wounds. Scars and keloids. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/medical_professionals/publications/Everyday-Wounds-Ch1 . Accessed June 24, 2005.

Keloids. British Association of Dermatologists website. Available at: http://www.bad.org.uk/public/leaflets/keloids.asp . Accessed December 12, 2006.

Keloids. British Association of Dermatologists website. Available at: http://www.bad.org.uk/public/leaflets/keloids.asp . Accessed June 24, 2005.

Keloids. National Library of Medicine. Medical Encyclopedia website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000849.htm . Accessed December 12, 2006.

Keloids. National Library of Medicine. Medical Encyclopedia website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000849.htm . Accessed June 24, 2005.

Keloids and hypertrophic scars. American Osteopathic College of Dermatology website. Available at: http://www.aocd.org/skin/dermatologicdiseases/keloids_and_hypert.html . Accessed June 24, 2005.

Larson D. Preventing keloids. Medical College of Wisconsin website. Available at: http://healthlink.mcw.edu/article/996370237.html . Accessed December 12, 2006.

Larson D. Preventing keloids. Medical College of Wisconsin website. Available at: http://healthlink.mcw.edu/article/996370237.html . Accessed June 24, 2005.

Malaker K, Vijayraghavan K, Hodson I, Al Yafi T. Retrospective analysis of treatment of unresectable keloids with primary radiation over 25 years. Clin Oncol . 2004;16:290.

Newsome RE, Langston K, Wang A, Jansen D. Wound Healing, Keloids. eMedicine website. Available at: http://www.emedicine.com/plastic/topic404.htm . Accessed December 12, 2006.

Newsome RE, Langston K, Wang A, Jansen D. Wound Healing, Keloids. eMedicine website. Available at: http://www.emedicine.com/plastic/topic404.htm . Accessed June 24, 2005.

Scars don’t have to mark your skin. American Academy of Dermatology website. Available at: http://www.aae.org/public/news/newsreleases/scars_alster.htm . Accessed June 24, 2005.

Shaffer JJ, Taylor SC, Cook-Bolden F. Keloidal scars: A review with a critical look at therapeutic options. J Am Acad Dermatol . 2002; 46:S63.

Skin of color. American Academy of Dermatology website. Available at: http://www.aad.org/public/Publications/pamphlets/BlackSkin.htm . Accessed December 12, 2006.

Skin of color. American Academy of Dermatology website. Available at: http://www.aad.org/public/Publications/pamphlets/BlackSkin.htm . Accessed June 24, 2005.

What is a keloid? Skin Research Group, University of Miami website. Available at: http://dermatologyresearch.med.miami.edu/x20.xml . Accessed December 12, 2006.

What is a keloid? Skin Research Group, University of Miami website. Available at: http://dermatologyresearch.med.miami.edu/x20.xml . Accessed June 24, 2005.



Last reviewed January 2008 by Ross Zeltser, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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