What are Keloids?
A keloid scar is scar tissue that occurs when the healing process has gone into overdrive and too much collagen is produced causing the scar to raise up over the level of the surrounding skin. So much scar tissue is formed that is often impossible to tell what the original injury looked like, as the scar is now much larger than the original wound.
When new, keloids are pink and very firm. They can occur with any type of cut to the skin and usually occur within a few weeks of the injury. Many keloids will eventually become white and flatten out but this can take many years sometimes. A scar that keloids will never look as good as a scar that did not keloid. Many keloids will continue to produce collagen and remain hard and pink for years prior to going into remission. Some Keloids never resolve.
Active keloids often have symptoms. They can be very sensitive to clothing passing over them, they often have spontaneous jabbing or prickling pain or itching that can be quite bothersome.
There are stretched scars that many confuse with keloids. Stretched scars are when a cut has occurred over an area where the skin is under tension during the 3 to 4 months of the initial healing phase. In this case the scar is widened by the tension ( very often around the shoulder, chest or on the back) but is not raised above the level of the surrounding skin and has no symptoms. These can also occur in people that are growing taller or wider during the healing process ( belly of a pregnant woman, leg of a 13 yr old boy).
Some people are "Keloid Formers" and are at higher risk to get keloids than others. Darker pigmented races have a higher incidence but they occur in all races. Teenagers are much more likely than other age groups to form keloids. Some people are spontaneous keloid formers, when they cannot recall the initial injury or it was a trivial injury (pimple or mosquito bite) that caused the keloid to form. Spontaneous keloids generally occur on the earlobes, chest and upper back.
Why do they form?
The mechanism has not yet been identified. It is curious why some wounds will keloid and others not. I have seen 3 identical appearing cat scratches on a patients arm where one of the scratches keloided and the others did not. There appear to be many factors at play. Infection may increase the risk of keloiding as well.
How can you treat Keloids?
Treatments can begin as soon as it appears the scar is elevating over the surrounding skin.
Cryosurgery for Keloids
Freezing a keloid with liquid nitrogen is also an effective strategy but does cause a wound that will then need to heal. This treatment may also take several sessions.
Laser Treatments for Keloids
The V-beam (yellow pulsed dye laser) is effective in treating keloids by closing down many of its vessels, less effective is Intense pulsed light (IPL) for keloid treatment but is still useful. These treatments take many sessions. However, for normal pink scars after surgery they are very effective in smoothing out the scar and taking the red out.
Unfortunately there is close to a 50% recurrence rate for keloids that have been excised. In order to excise it the scar is made even longer than the original keloid (so as to get around it). In order to decrease the rate of recurrence it is important to also treat the surgical area with an additional keloid treatment while it is healing.
Medication for Keloid prevention
In patients that are known keloid formers, a medication called imiquimod can be applied immediately after the cut and during the healing process to decrease the chance of a keloid from forming. This works well when a patient is is having surgery. Unfortunately, the imiquimod will cause a rash around the wound which can appear like an infection and needs close monitoring. Imiquimod will decrease the chance of keloiding by about 20%.