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Keloid

keloid


Keloid is an overgrowth of the scar tissue that develops around a wound, usually after the wound has healed. Keloid usually grows beyond the borders of the original wound whereas in a hypertrophic scar the tissue stays within the wound border.

What causes keloid?

The exact cause is not known. It can develop after acne spots and boils, body piercings, burns, lacerations and surgical wounds. Infection increases the risk. There seems to be a problem with cells called fibroblasts which are responsible for the production of scar tissue (collagen). Hormones, genetic factors and problems with the immune system have all been suspected of being involved.

Who gets keloid?

Keloid scars are more common in people with darker skins, especially African-American races. The peak age is 10-30 years and keloids are less common at the extremes of age. There may be a family history of tendency to develop keloids.

What are the symptoms of keloid?

Keloid typically starts to develop about three months after the original skin damage although it can take up to a year. The first thing you will probably notice is that rubbery scar tissue starts growing beyond the borders of the original damage. The common areas are the breastbone, shoulder, earlobe and cheek. Once they stop growing most keloid scars remain the same size or get smaller.

What is the treatment for keloid?

No treatment is one hundred percent effective and you may be offered a combination of methods.

Steroids

Most keloid respond to injection of a steroid called triamcinolone into the scar. Another method is to use steroid-impregnated tape which is applied to the scar for 12 hours a day.

Pressure or occlusive dressings

A dressing which applies pressure and/or prevents air from coming into contact with the scar is used. The dressing must be used for 12-24 hours a day for many weeks. Preparations used are silicone as a gel or impregnated sheet, or polyurethane self-adhesive patches.

Surgery

Removing the keloid scar by surgery can result in an even bigger scar, so you may be offered additional treatments such as steroid injections, occlusive or pressure dressings or radiotherapy.

Radiotherapy

This has the risk of causing cancers and should be reserved for difficult cases in areas well away from internal organs.

Cryotherapy

Cryotherapy (the use of a probe to freeze tissue) has been used alone or in combination with other treatments, especially steroid injections. In the early stage it may stop keloid from growing. It can cause pale areas at the site of treatment.

Laser treatment

Pulsed dye lasers and Nd:YAG lasers are types reported to give the best results whilst having few side-effects. Pulsed dye lasers are less effective on dark skin.

Interferon therapy

Interferon alfa is an antiviral drug. It has been found to improve the effect of steroid injections but does not work very well on its own.

Cytotoxic drugs

Two types commonly used for keloid scars are 5-fluorouracil and bleomycin. They are injected into the scar and may be used alone or in combination with other treatments.

Retinoids

Usually used in acne, these have shown some improvement when applied to the surface of the keloid or injected into it.

Can keloid be prevented?

If you are in an at-risk group or have already had a keloid you should avoid body piercing and tattoos. You should also steer clear of unnecessary operations such as cosmetic surgery, especially in those areas of the body where keloid is prone to develop. If you get acne, you should make sure it is treated effectively at an early stage so the spots do not scar.


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