What is Keloid?
Keloids are lumps that arise when our skin heals unusually after injury or inflammation. The appearance of keloids can be influenced by genes and environmental factors. People with darker skin, such as those of African, Asian, or Hispanic descent, have a higher chance of developing keloids.
Keloids are caused by overactive skin cells, known as fibroblasts, that produce excessive amounts of a protein substance called collagen, along with other growth factors. Under a microscope, these appear as unusually large, hardened bundles of collagen, known as ‘keloidal collagen’, and a lot of fibroblasts.
In terms of appearance, keloids look like firm, rubbery bumps that form in an area where the skin had previously been injured. Unlike ordinary scars or hypertrophic scars, keloids grow beyond the initially injured area. Some people may experience discomfort such as pain, itchiness, or a burning sensation in the affected area.
There are several methods to treat keloids, but there’s no one-size-fits-all solution. Common treatments include injections or topical application of steroids, freezing the area (cryotherapy), surgical removal, radiation therapy, and using a laser. However, their success rates vary from person to person.
What Causes Keloid?
Both your genes (traits passed down from your parents) and things in your environment can play a part in the development of keloids. Keloids are raised, often dark-colored scars that form where the skin has healed after an injury.
If you’re prone to getting keloids, you might develop one after getting hurt or irritated in any way, such as surgery, piercings, acne, tattooing, insect bites, burns, cuts, scratches, shots, or any other event that leads to skin inflammation.
It’s also possible that tension in a healing wound can contribute to keloid formation. Basically, when the skin is stretched too much during recovery, this might increase the chances of a keloid forming.
Risk Factors and Frequency for Keloid
People with darker skin, such as those of African, Asian, and Hispanic origin, are more likely to develop keloids compared to those with lighter skin. The percentage of people from these groups who develop keloids ranges from 4.5% to 16%. The likelihood of keloids forming increases during times of hormonal change, like pregnancy and puberty. People with a family history of keloids are also at increased risk, but we don’t know exactly which gene might cause this. Additionally, certain rare genetic conditions, like Rubinstein-Taybi and Goeminne syndrome, can increase the risk.
Signs and Symptoms of Keloid
Keloids are non-cancerous growths that can form as a response to trauma or inflammation of the skin. They typically begin to show up anywhere from 1 to 3 months to up to a year after an injury. Some keloids may seem to appear without any prior skin damage, but it’s likely that the injury was minor or forgotten, or that the keloid took months or even years to develop. Keloids can form on any part of the body, but are most often seen on the shoulder, upper chest, upper back, and ear. Less common locations include the eyelids, genitals, palms of the hands, and soles of the feet.
Keloids have the appearance of firm, rubbery bumps that usually rise above the surrounding skin. They can be either narrow and sticking out (pedunculated), or wide and flat (plaque-like). One key feature of keloids that helps to differentiate them from thickened scars (hypertrophic scars) is that they always grow beyond the site of the original wound. Keloids also vary in color, ranging from red to flesh-toned or darker, and these colors may change over time as the keloid matures.
Even though keloids aren’t cancerous or harmful, they often cause symptoms. In one study, about 86% of people with keloids reported itchiness, and about 46% reported pain. Other symptoms might include tenderness and a burning sensation. Additionally, due to their potential size and disfigurement, keloids can have a major impact on a person’s appearance and self-image.
Testing for Keloid
The diagnosis for your condition is mostly determined through a doctor’s examination. If there’s any uncertainty about the diagnosis, a biopsy (a medical procedure where a small sample of your body tissue is removed for examination) might be needed. If a biopsy is done and it confirms the doctor’s diagnosis, no further tests are generally required.
Treatment Options for Keloid
Keloids are a difficult type of scar to treat. They can actually get worse if not treated correctly. For those who are prone to developing keloids, it’s crucial to try to prevent them from forming in the first place. This could mean avoiding things like ear piercing and tattoos. If you have to have surgery or get injured, there are things you can do to lessen the chance of a keloid scar forming. Keeping wounds closed securely and making sure they clot properly can help. You might also find dressing the wound with silicone sheets helpful as this takes some of the tension off it. Wearing compression garments can also reduce the chance of a keloid forming. It’s recommended that these are worn for more than 23 hours a day and for at least 6 months.
If keloids have already formed, there are several treatments available to help manage their symptoms:
– Corticosteroids- These are often the first choice of treatment for keloid scars. Usually, you’ll need to have injections every 4-6 weeks. You can also use topical creams and tapes that contain corticosteroids to help with symptoms such as itching and burning.
– Cryotherapy- This is a form of treatment that uses cold temperatures to destroy scar tissue. It usually requires multiple treatments, but it’s worth noting that it can change the pigment of your skin, so might not be suitable for darker skin types.
Surgical excision- This is where the keloid scar is surgically removed. However, because keloids can often come back after surgery with a recurrence rate of between 45% and 100%, it’s usually combined with other treatments like radiation or more steroid injections.
– Laser Treatment- Laser treatments can be used to flatten and reduce the size of keloids. These treatments are usually done in multiple sessions.
– Other treatments- Other forms of treatment can include topical applications like imiquimod, injections of botox or bleomycin, another medicine called 5-fluorouracil, and using silicone gel sheets. These can all be used alone or in combination with the other treatments mentioned.
It’s important to know that it might take multiple treatments before you see an improvement in your keloid scars, and they might not disappear completely. But using a combination of treatments that suit your needs can lead to the best results.
What else can Keloid be?
When a doctor thinks a patient might have keloids (overgrown areas of scar tissue), there are a few other conditions they need to keep in mind. Certain key features can help the doctor decide if a skin biopsy is needed. Firstly, hypertrophic scars can look like keloids and are also due to skin injury. They’re usually smaller, though, and stay strictly where the injury happened, unlike keloids which can keep growing and affect the skin nearby.
Dermatofibroma is another skin condition that results in an unusual scar response. It typically causes a skin colored or darker than normal lump or bump. A key sign of these is the ‘dimple sign’, which is a central indentation when you apply pressure to the sides.
Dermatofibrosarcoma protuberans is a harsh but rare tumour that occurs on the trunk and upper limbs in young adults. As opposed to keloids, there is no trauma that causes these and their borders are more irregular. Other keloidal variants include morphea and scleroderma. With such conditions, the disease progresses even without a known injury event, and may also show other signs of having connective tissue disease.
- Xanthoma disseminatum is a rare condition with skin lesions (abnormal skin growths or patches) that may look like keloids. The lesions occur suddenly in a symmetrical pattern. It might also affect other body systems, potentially causing a condition called diabetes insipidus.
- Lobomycosis is a deep fungal infection. It presents as a slow-growing lump on the extremities and looks like a keloid. People usually get infected through exposure to dolphins or rural soil in Central and South America.
What to expect with Keloid
Keloidal scars are harmless, but treatment is usually aimed at providing relief from symptoms or addressing appearance-related worries.
