Keloids

What are they?

A keloid scar is a special kind of scar that, although harmless, and non-contagious, can have needle-like jabbing pain and itching. Keloids are often a cosmetic problem: lumps that can be dark pink, firm and rubbery. They may grow larger with time. They should not be confused with hypertrophic scars, which are usually confined to the original area of damage. Keloids do not go away on their own.

Where do Keloids come from?

Keloids can result from injury to the skin. Collagen that repairs the wound overgrows the area, resulting in a lump many times the size of the injury. Keloids can be found a sites of a piercing (earlobes, eyebrows, chest etc) or severe acne or chickenpox scarring. Darker skin tones are more prone to Keloids.

How can you treat Keloids?

Cryosurgery is an excellent treatment for keloids which are small and occur on lightly pigmented skin. It is often combined with monthly cortisone injections. The use of cryotherapy is limited since it causes skin blanching. It freezes the skin and causes sludging of the circulation beneath, effectively creating an area of localized frostbite.

Surgery requires great care during and after the operation. Keloids that return after being removed may be larger than the original. There is a 45 percent recurrence of keloids that are surgically removed. However, keloids are less likely to return if surgical removal is combined with other treatments.

Intense Pulsed Light can also be used to treat keloids. The flashing of the this light onto the red scar diminishes its blood flow causing it to blanch and crust up and heal smaller. This may take several treatments.

Surgical or laser excision may be followed by intralesional injection with a corticosteroid to try to prevent recurrence.

Steroid injections are best used as the scar begins to thicken or if the person was a known keloid former. Series of injections with triamcinolone acetonide, kenalog or another corticosteroid may reduce keloid size and irritation, but injections are often uncomfortable, and in larger and/or harder scars can be difficult and can be performed with a local anesthetic. The treatment area can become very painful as the anesthetic wears off.