Chances are you have probably seen a keloid scar before. These lumpy scars that commonly form on the chest and back after trauma or inflammation in those with skin of colour are a pain (literally!) and are often difficult to treat.

Our understanding of keloids and scar biology has advanced in recent years. We used to think of keloids as benign tumour type growths but we now know that keloids are an inflammatory condition. This means that while we treat them and often settle them with a combination of medical or physical therapies, they can become active again in the future.

Wound healing can be categorized into four overlapping processes: coagulation, inflammation, proliferation and remodelling. Keloids occur when the inflammatory phase is prolonged. When the inflammatory phase is prolonged, the development of new blood vessels in the area is seen (a process called angiogenesis). This induces excessive accumulation of collagen

The kinds of things that result in keloid formation include herpes zoster infections, acne, folliculitis, ear piercings and surgery. All of these processes affect the reticular dermis which is the lower layer of the dermis where there is a dense collection of collagen and elastin fibres

Keloid Scar Beforeandafter Chromadermatology
Dumb-bell keloid on the left ear before and after treatment

Risk factors for developing keloids include
Family history – you are more likely to get keloids if someone in your family has them
Skin of colour – you are more likely to get keloids if you have non-caucasian skin types. It is the fifth most common skin disease in adult black patients in the United Kingdom and the most common skin disease among ethnic Chinese patients in Asia.

So how can keloids be treated?  Those who may be at risk of keloids should carefully consider unnecessary surgery and piercings. Make sure you treat inflammation early – don’t leave those pimples lying around. Prevention is better than cure!

Special dressings, compression-wear, injections and lasers are some of the things that can help with the appearance, itch, pain and pulling sensation that can occur with keloids but the size, location and type of keloid as well as a person’s medical health are all important to consider before coming up with a management plan.