What Are Keloids? Symptoms, Causes, Diagnosis, Treatment, and Prevention

A keloid, or keloid scar, is a kind of overgrown scar, or an overly aggressive healing response to a wound.

Scars, which form as a response to a wound such as a minor burn, cut, or abrasion, are part of the body’s natural healing process. In most cases, scars usually grow smaller and fade over time, but in some people, the skin can overreact to the damage and lead to scars that are much larger than the original wound. These scars are called keloids.

• It appears gradually. It can take as long as 3 to 12 months or even longer before you to notice a keloid beginning to develop; most tend to appear within a year of the original skin damage.
• It may also grow quickly. Sometimes keloids spread fast, and may, for example, triple in size in as little as a few months.
• Your scar is itchy, tender, or painful. These symptoms usually stop once the keloid is developed.
• Your scar is easily irritated. It may become irritated from friction, such as rubbing against clothing.
• It gradually turns darker. A keloid typically begins as a pink, red, or flesh-colored scar that darkens over time and ends up looking darker than the skin around the scar.

• Ears
• Neck
• Shoulders
• Chest
• Back

Keloids can be more than just skin imperfections. Depending on the size of the scar and where it is on the body, it can affect how well you can move that area of the body. And for some people, physical symptoms such as pain or itchiness can impact your psychological health. Others may feel that their keloid is noticeable or unsightly and that may take a toll on their emotional well-being.

If you are prone to developing keloids, any type of skin injury that can cause a scar can lead to the formation of a keloid. Some common causes of keloids include:

• Surgical cuts or any other types of cuts
• Acne and chickenpox blemishes or scars
• Burns
• Body or ear piercings
• Tattoos
• Insect bites
• Vaccination shots
• Wearing tightly braided hair

In rare cases, keloids can form on skin that hasn’t been injured. These are referred to as spontaneous keloids.

• Being of African, Asian, or Hispanic Descent
• Having a Family History of Keloids As many as one-third of people who get keloids have a close relative (such as a parent or sibling) who is prone to keloids.
• Being Between 10 and 30 Years Old Most people begin to notice keloids developing on their skin in their twenties, although these scars can start earlier or later.

Keloids are usually diagnosed by a dermatologist who will take your medical history and conduct a visual examination of the scar to check its size, shape, and growth pattern. Your doctor may also perform a skin biopsy to rule out more serious conditions such as nodular scleroderma, a type of connective tissue disease, or lobomycosis, a fungal infection of the skin.

Prognosis of Keloids

While keloids are benign (noncancerous) growths, they are nevertheless difficult to treat and frequently grow back even after they are surgically removed. But your dermatologist may be able to suggest measures that can help reduce the odds of keloids returning after treatment or at least ways to minimize their appearance.

Keloids can continue to grow for months or even years. They eventually stop growing but they do not disappear without treatment. In some cases, as mentioned above, keloids can return after they have been removed.

Keloids generally do not need to be treated. But treatment may be helpful if a keloid scar causes discomfort or hampers movement (if it covers a joint or a large area, for example). People may also seek treatment for a keloid if the scar impacts their self-esteem and how they feel about their appearance. For instance, if the scar is large or is located in a very visible place on your body, your doctor may be able to help you find ways to reduce the size and prominence of the keloid.

There is no one treatment that works best for all keloids. Dermatologists typically tailor the treatment to the individual based upon factors such as age and type of keloid. Keloids are difficult to banish completely, and using more than one type of treatment often improves results. Dermatologists therefore often recommend two or more types of treatments for their patients.

Treatment options for keloid scars include:

• Cryotherapy This treatment, which works best on small keloids, involves freezing the keloid from the inside out. This method is often used before or after corticosteroid injections to help make the injections more effective, says the AAD.

  

• Pressure Therapy This involves using a device or a special piece of clothing to put pressure on the area and reduce blood flow to the site to inhibit the regrowth of the keloid. While effective, this treatment, which is often used after surgery, can be difficult for many people to stick to. These devices can be uncomfortable, and people need to wear them for 6 to 12 months.
• Radiation Therapy In this treatment, the keloid is surgically removed and low-dose radiation is used to prevent scar tissue from regrowing.
• Laser Therapy This treatment uses high-energy light beams to reduce the size and lighten the color of a keloid. Laser therapy is commonly combined with other treatments such as corticosteroid injections or pressure therapy.
• Silicone Gels and Patches These silicone-based treatments help flatten and reduce the size and color of the scars.
• Ligature Your doctor may opt to use a surgical thread to tie around the keloid, which cuts off the blood supply so that the keloid will naturally fall off after a period of time.
• Surgery Surgery is typically combined with other therapies such as corticosteroid injections or silicone treatments; that’s because in nearly 100 percent of cases, keloids grow back after surgical removal, according to the AAD.

  

Medication Options

• Corticosteroid Injections These injections are administered into the keloid to help reduce inflammation and constrict blood vessels, which may help relieve swelling, itchiness, or tenderness.
• Fluorouracil This chemotherapy medication, which is usually used to treat cancer, may be used in conjunction with corticosteroids.

Alternative and Complementary Therapies

While there are a number of products on the market that claim to be effective for prevention or treatment of keloids, there isn’t a lot of research that provides solid evidence to support those claims. Here are two alternative and complementary therapies that have some science behind them.

Related: What Are 'Natural' Skin-Care Products, and Are They Actually Better for You?

Prevention of Keloids

• Try to avoid body piercings, tattoos, or any elective surgery, as keloids can occur after these procedures.
• Treat any injury right away, no matter how minor it is; this may help your skin heal faster and reduce your risk of scarring.
• If you do find yourself with a wound, talk to your dermatologist about how best to care and dress it. This will help you prevent keloid scars from developing.

Keloids usually don’t pose a threat to your health and may not need to be treated. But keloids that are prominent and visible, such as those that occur on the face, may also impact a person’s self-esteem, and treatment may help address that.

People who have darker skin have a higher risk for developing keloids than people with fairer complexions. Researchers are working to learn more about how genetics may play a role in keloid formation in the hopes that one day, we may be able to find new methods of diagnosis, prevention, and treatment for this condition.

Some skin conditions can resemble keloids and require a diagnosis from a doctor to identify them. They include:

Hypertrophic Scars Experts differ as to whether these scars are really different from keloids, but there do seem to be some differences.

• Unlike keloids, which can extend far beyond the injury site, hypertrophic scars don’t grow beyond the boundaries of the original wound. These scars appear in the first weeks after a wound heals and then develop over the next six to eight months, after which they stop. Keloids, on the other hand, begin to grow anytime in the first year after the injury and can continue to spread for months or even years.
• Hypertrophic scars are not more common in people who have darker skin.
• Hypertrophic scars respond better to treatment and do not grow back as frequently after surgery as keloids, according to research published in June 2020 in Experimental Dermatology.

  

Nodular Scleroderma Also known as keloidal scleroderma, nodular scleroderma is rare form of systemic sclerosis, an autoimmune disease that affects the connective tissues. Nodular scleroderma can cause the development of firm plaques or nodules on the skin — typically on the upper trunk, arms, face, and neck — that look like keloids.

Lobomycosis Also known as keloidal blastomycosis or Lobo disease, this chronic fungal skin infection can cause the development of keloid-like lesions. It’s more common in the Amazon region and in South and Central American countries.

American Academy of Dermatology Association

Dermatologists are the healthcare professionals who can diagnose and treat keloids. This website provides thorough and detailed information about all aspects of keloid scars, from how they form to what you need to know about the latest treatments to remove keloids and reduce their risk of regrowth.

Keloid Research Foundation

This nonprofit medical research and educational foundation aims to foster scientific research in keloid disorder and promote education and advocacy to those who are prone to developing these types of scars. On their website, you can find patient stories, educational resources, information about the latest research, and much more.

NYU Langone

The New York University’s Langone Health website is full of in-depth information on keloids and other scars. If you’re looking for detailed information on diagnosis, treatment, surgery, recovery, and support, this is a great resource.