The keloid is a bump of scar tissue that grows past a wound’s bounds. It may keep growing weeks after your skin heals. More common in dark skin, keloids can form anywhere, but often they’re on earlobes, shoulders, the upper back, chest, or cheeks. They’re not harmful, so if they don’t bug you, you can leave them alone. But if one is too big or itchy, you can have it treated or removed. To prevent them, avoid piercings or surgery you don’t need.
What are keloid risk factors?
Individuals with darkly pigmented skin are 15 times more likely to develop keloids, with those of African, Hispanic, and Asian ethnicities at greatest risk. Keloids are equally common in women and men. Keloids are less common in children and the elderly. Although people with darker skin are more likely to develop them, keloids can occur in people of all skin types. In some cases, the tendency to form keloids seems to run in families. Genetic studies have not as yet delineated the exact genes responsible for this predisposition.
What are the treatments for keloids?
1. Cortisone injections (intralesional steroids): These are safe and not very painful. Injections are usually given once every four to eight weeks into the keloids and usually help flatten keloids. However, steroid injections can also make the flattened keloid redder by stimulating the formation of more superficial blood vessels. (These can be treated using a laser; see below). The keloid may look better after treatment than it looked to start with, but even the best results leave a mark that looks and feels quite different from the surrounding skin.
2. Surgery: This is risky, because cutting a keloid can trigger the formation of a similar or even larger keloid. Some surgeons achieve success by injecting steroids or applying pressure dressings to the wound site for months after cutting away the keloid. Radiation after surgical excision has also been used.
3. Laser: The pulsed-dye laser can be effective at flattening keloids and making them look less red. Treatment is safe and not very painful, but several treatment sessions may be needed. These may be costly, since such treatments are not generally covered by insurance plans.
4. Silicone gel or sheetings: This involves wearing a sheet of silicone gel on the affected area continuously for months, which is hard to sustain. Results are variable. Some doctors claim similar success with compression dressings made from materials other than silicone.
5. Pressure: Special earrings are available, which when used appropriately, can cause keloids on the earlobe to shrink significantly.
6. Cryotherapy: Freezing keloids with liquid nitrogen may flatten them but often darkens or lightens the site of treatment.
7. Interferon: Interferons are proteins produced by the body's immune systems that help fight off viruses, bacteria, and other challenges. In recent studies, injections of interferon have shown promise in reducing the size of keloids, though it's not yet certain whether that effect will be lasting. Current research is underway using a variant of this method, applying topical imiquimod (Aldara), which stimulates the body to produce interferon.
8. Fluorouracil and bleomycin: Injections of these chemotherapeutic (anti-cancer) agents, alone or together with steroids, have been used for treatment of keloids.