Scars or Keloids? What are keloids and how can they be treated?

“This lump appeared on my shoulder and it’s appeared out of nowhere!”

It’s normal to get a little scar as your skin heals up after any injury like a cut, burn or scratch. But occasionally, a type of scar, called a keloid, can develop. And while keloids don’t cause any other medical problems, they can be quite disfiguring and can cause itch and discomfort. They are most common on the chest, shoulders, upper back and ears. 

Chroma Dermatology in Melbourne often see and treat patients with keloids because it is common in those with skin of colour. This blog will explore what keloids are and how they can potentially be treated. 

More about Keloids

Keloids are a type of skin scar that contain an excessive amount of collagen. The world keloid is derived from the Greek work “‘chele” which means “crab’s claw.” This is because a portion of it can extend and creep under the surrounding skin.

Keloids usually occur after injury or inflammation in the skin. They usually develop on the upper chest, upper back and shoulders. People with skin of colour have a higher risk of developing keloids. People with a past or family history of keloids also have a higher risk of developing them.

The cause of keloid formation is still not fully known.

  • Family history: Genetic factors definitely play a role with an increased risk of keloids seen in those who have a family member who has them
  • Skin of colour: People with darker skin types – Asian, Indian, African and Pacific Islander skin types are more likely to develop keloids
  • Tension across wounds: areas with high tension include the chest and back which explains why keloids are more common in these areas.

Excessive collagen (a protein made in wound repair and one that naturally occurs in the second layer of the skin) formation occurs in areas of injury to the skin. The injury can be minor, like a cut or burn but can also be more significant, like a tattoo, the site of an ear piercing or a surgical scar.  Keloids may also occur as a result of inflammation in the skin (such as in acne (pimples), insect bites or abscesses) or in areas of increased skin tension or tightness.

Keloids typically develop slowly and usually appear months after the skin injury. Keloid formation is rarely spontaneous (occurs without an injury).

As they say, prevention is best because keloids are difficult to treat.

  1. Avoid injury and treat inflammation in the skin early: Those who may be at risk of keloids should carefully consider unnecessary surgery and piercings and should try to treat any significant skin inflammation like acne (pimples) quickly and effectively.
  1. Steroid injections: The most widely used treatment are steroid injections into the keloid. Different concentrations of corticosteroids can be used depending on the size and location of the keloids. The treatment won’t make the scar disappear but is very effective in flattening it and decreasing itch and discomfort that can be caused by them. Multiple injections, spaced about 8 weeks apart, may be needed for medium to large sized keloids and maintenance treatments are often required too. The injections can cause some discomfort but usually ice, cold air or numbing creams are enough to control the discomfort.

After the treatment, a smallband aid or dressing is usually applied to the area so you can get straight back to work/school without any worries.

  1. Silicone gels or creams and pressure dressings can be helpful when used in conjunction with the steroid injections. Your dermatologist or treating doctor will advise you which ones may be best for you to try.
  1. Lasers: vascular lasers are best used to treat keloids that are very red. Multiple laser treatment sessions are required to gradually decrease the intensity of the redness over time.
  1. Other treatments that can be used including compression, liquid nitrogen, 5-fluorouracil (5-FU), radiotherapy and tablets (like hydroxychloroquine) but these are usually used for patients that don’t respond to the injections.

In general, cutting the keloid out (i.e. surgery) often results in a larger keloid, unless the surgery is combined with other techniques (e.g. intralesional steroids, radiotherapy) or the surgeon is able to successfully reduce the tension on the wound. Keloids (dumbbell keloids) on the ear are a more complex type of keloid that requires a combination of injections and surgical techniques to try to improve the appearance.

For more information on keloid scars and treatment options, click here or organise a consultation with Chroma Dermatology