Keloid skin lesions represent a distinct form of abnormal wound healing, resulting in a raised scar that grows significantly larger than the original injury site. While these growths are benign and pose no serious health risk, their appearance can cause considerable cosmetic concern. They can also cause physical symptoms such as itching, pain, or restricted movement. The formation of a keloid involves a malfunction in the body’s natural repair process, leading to an overproduction of fibrous tissue. Understanding the unique characteristics of this condition is important for seeking appropriate management options.
What Defines a Keloid
A keloid is characterized by an excessive accumulation of dense, fibrous tissue that continues to proliferate long after the initial wound has closed. These growths often present as firm, rubbery, dome-shaped nodules with a smooth, shiny surface texture. The color can vary significantly, ranging from pink or red to darker shades of brown, often differing from the surrounding healthy skin.
The underlying biological process involves an unchecked phase of fibroblastic activity, the stage where the body typically produces new connective tissue to repair a wound. In keloids, fibroblasts remain hyperactive, leading to an overproduction of collagen, specifically the large, thick bundles known as keloidal collagen. This synthesis and deposition of collagen causes the scar to become elevated and hard.
Factors Contributing to Formation
The development of a keloid is largely influenced by a combination of genetic and environmental factors, making certain individuals highly predisposed. A clear genetic component exists, as having a family history of keloids significantly increases an individual’s risk for developing them. This predisposition is particularly noted in populations with darker skin tones, including individuals of African, Asian, and Hispanic descent, where the incidence rate is notably higher.
The growths are typically triggered by some form of skin trauma, though the injury itself may be relatively minor. Common triggers include surgical incisions, ear piercings, burns, severe acne, vaccination sites, and even insect bites. Keloids are also more likely to form in areas of the body where the skin is under higher tension, such as the upper chest, shoulders, earlobes, and back.
Keloids Versus Hypertrophic Scars
Keloids are frequently confused with hypertrophic scars, as both are types of raised, excessive scar tissue that form after an injury. The defining difference, however, lies in their growth pattern relative to the original wound boundaries. A hypertrophic scar remains strictly confined to the area of the initial injury, appearing as a raised, thickened scar that respects the wound margins.
A keloid exhibits invasive growth, spreading outward into the surrounding healthy skin tissue. Hypertrophic scars generally develop within weeks of the injury and often regress or flatten spontaneously over time, typically within a year or two. Keloids, conversely, can appear months or even years after the initial trauma, rarely regress without intervention, and continue to grow slowly.
The distinction is significant because hypertrophic scars tend to respond better and more predictably to treatment than keloids. This difference in biological behavior—remaining contained versus spreading—informs the management strategies employed by dermatologists.
Options for Treatment and Management
The management of keloids is often challenging due to their high rate of recurrence following intervention. Therefore, treatment plans are typically personalized, involving a combination of modalities to achieve the best outcome. First-line, non-invasive approaches often focus on applying external pressure and hydration to the affected area.
Silicone gel sheets or silicone-based topical products are worn constantly over the scar. The occlusion and hydration provided by these products can soften the tissue and reduce scar size. Pressure garments, such as compression earrings for earlobe keloids, are also utilized to physically flatten the scar and limit its blood supply.
For established keloids, intralesional corticosteroid injections are a widely used medical treatment. The corticosteroid is injected directly into the scar tissue to reduce inflammation and suppress the excessive collagen production by the hyperactive fibroblasts. These injections are usually administered in a series every few weeks.
Cryotherapy involves freezing the keloid with liquid nitrogen, causing cellular damage and necrosis of the tissue. This option is particularly effective for smaller lesions and is often combined with steroid injections to improve success rates. Other injectable medications, such as 5-fluorouracil or bleomycin, may be used for keloids that do not respond to traditional steroid therapy.
Surgical removal is possible, but it carries a significant risk of the keloid returning, which is why it is rarely performed alone. Excision is almost always paired with an adjuvant therapy, such as immediate post-operative radiation therapy or corticosteroid injections, to significantly lower the recurrence rate. Laser therapy, particularly pulsed-dye laser, can also be used to flatten the lesion, reduce redness, and ease associated itching.
Prevention remains the most effective management strategy for individuals susceptible to keloid formation. This includes avoiding elective cosmetic procedures like piercings and tattoos. If surgery is required, specialized techniques to minimize wound tension and immediate post-operative scar management protocols are employed to reduce the chances of keloid development.