Keloids are firm, sometimes itchy bumps that can range from pink to red. They tend to gradually enlarge on skin that has previously experienced damage. Developed due to a result of abnormal scar formation, keloids pose more of a cosmetic concern than a medical one but can have distressing symptoms. In this blog post, we explain the causes of keloids, its implications and its treatment.
When a site on the skin has been injured, scar formation occurs with fibrous tissue that forms over the wound. This is your body’s response to repair and protect the site on injury. In cases where this scar tissue grows too much, it results in a growth that is smooth and hard to the touch - a keloid.
What do keloids look like?
It usually appears to be larger compared to the initial wound and can appear on any part of the body. Although, they are much more common on the chest, shoulders, earlobes, back, cheeks and jawline. Considered to be a scar, a keloid can rise above the original skin and abrupt its surroundings at times.
It usually is a smooth scar that ranges from pink to red. Irregularly shaped, they in fact enlarge in a progressive fashion which differentiates them from normal scars that regress over time. Some can take weeks or even months to completely develop before growth stops. Usually a cosmetic nuisance, it can tend to be quite irritating with symptoms such as itchiness and tenderness while some can even be painful.
It is important to remember that keloids are not harmful to your health even though they can cause quite a bit of discomfort and irritation due to friction. In VERY rare cases do keloids actually restrict body movement, and this is when they develop on joints or body areas where there is movement.
What are the causes of keloids?
Experts have yet to understand the exact reason as to why keloids develop. Bringing a little science into the mix, an alteration in signals at the cellular level that controls the response of proliferation and inflammation to heal wounds can cause the irregular growth of skin. This is considered to be a possible explanation but no definite explanation of the defect in ‘wound healing’ has yet to be discovered.
Different types of skin injury can result in a keloid scar:
- Grade 3 or 4 acne scars
- Chickenpox scars
- Ear piercings
- Incision sites (from surgery)
- Vaccination sites
Pro tip: Constant and excessive exposure to the sun may discolor a keloid making it darker than the surrounding skin. This makes a keloid much more visible! Try to always keep the scar covered to protect it from discolouration.
It is said that keloids may have a genetic predisposition, as they seem to run in generations. Science has said that a mutation in a gene known as NEDD4 may cause a vulnerability to keloid formation.
Who are vulnerable to keloids?
It is a general fact that people with darker skin tones are more susceptible to the development of keloids. This includes Africans, Hispanics and Asians! Although having no gender or skin type bias, they are less common in children and older individuals. Other risk factors of keloid formation can include individuals younger than 30 and pregnancy.
Minor injuries such as body piercings are the most popular place for the formation of keloid scars. Although this is a known fact, it is near to impossible to know if a piercing will develop a keloid as doctors are unsure of its cause of origin.
How do doctors diagnose keloids?
Dermatologists are able to diagnose keloids and offer advice for treatment if needed. Keloids are diagnosed through a visual examination and history taking. Your dermatologist will ask you if the site suffered any injury in order to explain to you why a keloid must have formed.
Can you prevent keloids?
Keloids are not preventable per say as the reasons of their formation is not set in stone. It is likely that if you are susceptible, have a genetic predisposition or have an existing keloid, that you may continue to have them.
Pro tip: If you have risk factors or previous keloid formation, it is best to avoid body piercings, elective (unnecessary) surgeries and tattoos! This is possibly the only form of prevention.
How can keloids be treated?
A keloid forms when your body tries to repair the injured or damaged skin, but it's removal may cause scar tissue to regrow - at times larger in size than before. It is important that you speak to a dermatologist before you consider keloid removal, as they would have the best advice on your prognosis. There are a few keloid treatment to consider, AFTER you’ve consulted a dermatologist:
- Reduction of inflammation through corticosteroid injections: Usually given once every 4 - 8 weeks, it helps flatten the keloid.
- Compression or silicone gel pads after injury to skin (if prone to keloids): this consists of wearing the silicone pad on the affected site for months.
- Killing skin cells through the freezing of tissue
- Reduce scar tissue through laser treatments
- Shrink keloids through radiation
When you first see your dermatologist, most will suggest procedures that are not as invasive such as silicone pads and injections. It is important that you don’t self diagnose and definitely DO NOT self treat as for treatment to be effective, frequent application of treatment is required under the supervision of a dermatologist.
For larger keloids that may cause extreme discomfort such as restriction of movement, surgical removal may be suggested by your dermatologist. Although, it is said that the risk of getting another keloid after removal is quite high. Your dermatologist may even suggest treatments such as steroid injections to reduce the risk of another keloid formation at the site of removal.
There are NO effective home remedies for keloid removal or regression, so please don’t try anything you read on the internet. You may cause your keloid to be irritated which may lead to pain and discomfort sometimes warranting removal of a keloid that was otherwise not bothersome.
When should you opt for keloid removal?
A dermatologist should suggest the removal of a keloid, before you make a decision to remove it. As said above unnecessary invasive procedures on individuals that are prone to keloids can result in the formation of more keloids.
Although smaller keloids can be effectively treated, the challenge presents with bigger ones as mentioned in the treatment portion of this blog. You should note that a keloid may not completely go away, but symptoms can be helped!
Widely, keloids usually don’t require dire medical attention and shouldn’t be the cause of any stress. If it does seem to be growing or presents with symptoms of discomfort, a dermatologist should be consulted. Qualified professionals will be able to understand the state of a particular keloid through visual inspection and medical history thereby letting the patient know if they could benefit from its removal.
Although usually benign, rapid growth can be a sign if skin cancer, as any rapid growth. **A dermatologist will suggest a biopsy of the keloid in order to rule out any other medical condition - prevention is ALWAYS better than a cure. **
Keloids do not typically cause any side effects that are unbearable but may cause insecurity and discomfort depending on its location. Treatment can be done any time, but should only be done under the supervision of a dermatologist. If you are bothered by the symptoms or appearance, let your dermatologist know - he/she will let you know about the long term outlook based on the treatment chosen for you. Keep in mind that treatment is at times difficult and not all are effective - so preventing injuries as best as you can - if you are prone to keloid formation - is crucial.
Although mostly a cosmetic concern rather than a medical one, do not let a growing keloid go unchecked. Professionals can help ease your mind and discomfort along with giving you accurate advice on the RIGHT procedure that would help you with your skin growth.