Keloids

Keloids are scars that grow excessively and extend beyond the edges of the original wound, forming a firm, smooth and often shiny lump that is pink, red or darker than the surrounding skin. They can appear after surgery, a burn, acne, a piercing or a tattoo, and even after minor injuries. They are more common in darker skin and between the ages of 10 and 30.

What a keloid is

A keloid forms when, during healing, the body produces too much collagen and does not stop once the wound has closed. Unlike a normal scar, a keloid can keep growing for months or years, itch and hurt.

Keloids and hypertrophic scars

Keloids are often confused with hypertrophic scars. Both are raised scars, but:

• A hypertrophic scar stays within the limits of the wound, appears in the first weeks and usually improves on its own over time.
• A keloid invades the surrounding healthy skin, can appear months later and almost never goes away on its own; it also tends to come back after removal.

Why keloids form

Keloids have a clear genetic component: they are more common with a family history and in people with darker skin. Location also matters: the earlobe, chest, shoulders and upper back are the most prone areas, because the skin there is under more tension or movement.

Treatment of keloids

Keloids are difficult to treat because they recur often. Several techniques are usually combined:

• Corticosteroid injections into the keloid every few weeks: the first-line treatment; they flatten the keloid and relieve itching.
• Silicone sheets or gel and pressure therapy: help prevent and flatten keloids, especially after scar surgery.
• Cryotherapy (freezing) and laser: useful for small keloids or to improve colour.
• Surgery: removing a keloid with surgery alone carries a very high risk of recurrence, often larger. Surgery is therefore combined with injections or superficial radiotherapy in the following days.

People prone to keloids should avoid piercings and purely cosmetic surgery in high-risk areas, and tell their doctor before any procedure.