Image courtesy of DermNet NZ.

Image courtesy of DermNet NZ.

Keloids

What is it?

A keloid is a scar that overgrows following a wound. In fact, it goes on to become larger that the original wound, usually appearing thick, fleshy and raised.  The keloid occurs due to an over production of collagen, which is the structural protein of the skin.

Keloids can develop sometimes after very minor skin damage e.g following an acne spot, spreading well beyond the origin and most often a keloid is permanent.

Causes, Types & Symptoms

Unfortunately keloids are a poorly understood and researched skin concern with ethnicity, genetics and pigment (melanin) intensity being contributory factors.

Most theories of keloid development centre on keloids forming after trauma to the skin of an individual who already has a genetic predisposition.

Keloids tend to develop months or even years after the trauma has occurred and also have a tendency to continue to grow taking some time to reach a growth plateau.

Although usually presented as a cosmetic concern because they can be unsightly, keloids can also be quite painful, itchy and sore, especially during the active growth phase; so many sufferers will seek medical relief from the pain.

Following that keloids present no discomfort, thought if they are located over or near a joint, movement can be restricted.

Diagnosis & Treatment

Keloids are easily diagnosed following  a visual assessment   of the skin. Very rarely, a biopsy may be requested.

Unfortunately, there is no conclusive treatment pathway for keloids. The first therapy is avoidance of unnecessary trauma in individual genetically predispositioned to keloid or hypertrophic scarring e.g. ear piercing, tattoos, cosmetic procedures.

Surgical removal is an option, especially for bulky and uncomfortable keloids; however, the healing of the skin post op must be monitored carefully as keloids have a habit of returning.

There is some evidence to show Corticosteroids have some beneficial effect in treating keloids when used early enough. A common treatment is to inject the steroid into the keloid site. 

Some studies have shown off label use of Botulinum toxin A (BoTox) also effective when used as an early intervention.

Cryotherapy can also be tried alone or in combination with other treatment methods, though it can cause pigment loss.