Keloid Scars: Causes, Symptoms, and Effective Treatment Options

Introduction

Keloids are a common skin condition, with historical references dating back to ancient Egypt. These raised, often itchy scars can develop after skin injuries, such as cuts, burns, or surgical incisions. Although benign, keloids can cause significant discomfort and emotional distress due to their appearance and symptoms. This article provides a comprehensive overview of keloids, including risk factors, symptoms, diagnostic tests, treatment options, and self-care strategies. By exploring these aspects, patients can better manage their condition and improve their quality of life.

What Are Keloid Scars?

Keloids are overgrown scars that extend beyond the original wound boundary. This article covers risk factors, symptoms, diagnostic tests, medications, procedures, and home remedies for managing keloids.

Description of Keloid Scars

Keloids are raised scars that form when the skin heals after an injury. Unlike regular scars, keloids grow excessively and can become much larger than the original wound. They are thick, irregular, and often shiny. Keloids can vary in color, from pink to dark brown, depending on the individual’s skin tone.

The progression of keloids is unpredictable. They may develop soon after an injury or take months to appear. Once formed, keloids can continue to grow for weeks or even years. While not harmful, they can cause discomfort, itching, and tenderness.

Statistics show that keloids affect about 10% of people worldwide, with a higher prevalence in individuals with darker skin tones. They are more common in people of African, Hispanic, and Asian descent. Keloids can occur at any age but are most frequently seen in individuals between 10 and 30 years old.

Risk Factors for Developing Keloid Scars

Lifestyle Risk Factors

Certain lifestyle factors increase the likelihood of developing keloids. For instance, individuals who frequently undergo body piercings or tattoos may be at higher risk due to repeated skin trauma. Those with frequent acne breakouts or a history of severe acne may also be more susceptible to keloid formation. Minimizing unnecessary skin injuries and practicing good wound care can reduce the risk.

Medical Risk Factors

Medical conditions that affect the skin’s healing process can contribute to keloid development. For example, individuals with chronic skin conditions like eczema or psoriasis may have a higher risk. Surgical procedures, especially those involving large incisions or areas prone to tension, can also lead to keloid formation. Patients with a history of keloids should inform their healthcare providers before undergoing any surgery.

Genetic and Age-Related Risk Factors

Genetics play a significant role in keloid development. If a close family member has keloids, the likelihood of developing them increases. Research suggests that certain genetic markers may predispose individuals to keloid formation. Age is another factor, with younger individuals being more prone to keloids due to more active collagen production, which can lead to excessive scar tissue formation.

Common Keloid Symptoms

Itching

Itching affects about 50% of keloid patients, especially in the early stages of formation. Itching is caused by the overproduction of collagen, which irritates nerve endings in the skin. This sensation can be bothersome and may lead to scratching, which can worsen keloid growth. Topical treatments or antihistamines can help reduce itchiness.

Pain

Pain is reported by about 30% of individuals with keloids. The intensity varies and is often more pronounced in larger or more mature keloids. Pain occurs due to the tension and pressure exerted by dense collagen bundles on surrounding tissues and nerves. Over-the-counter pain relievers or prescribed medications may be used, depending on severity.

Tenderness

Tenderness affects about 40% of keloid patients, especially when the keloid is touched or subjected to pressure. Tenderness results from inflammation and abnormal collagen structure within the keloid. Avoiding tight clothing or activities that put pressure on the keloid can help alleviate tenderness.

Redness

Redness is observed in about 60% of keloid cases, particularly during the early stages. The redness is due to increased blood flow and inflammation in the affected area. As the keloid matures, the redness may diminish, leaving a more skin-colored or darker appearance. Laser therapy can help reduce redness.

Swelling

Swelling affects about 50% of keloid patients. It results from the inflammatory response and excessive collagen deposition, making the keloid appear larger and more prominent. Compression therapy and corticosteroid injections are common treatments to manage swelling.

Raised Texture

Raised texture is a hallmark of keloids, occurring in nearly 100% of cases. This symptom is due to excessive collagen accumulation, causing the skin to protrude above the surrounding area. Treatment options focus on flattening the keloid, such as silicone gel sheets or laser therapy.

Firmness

Firmness is experienced by almost all keloid patients. The firmness is due to dense collagen fibers that make the keloid feel hard and immovable compared to normal skin. Treatments like cryotherapy or intralesional corticosteroids aim to soften the keloid.

Discoloration

Discoloration affects about 70% of keloid patients. Keloids can appear darker or lighter than the surrounding skin, depending on the individual’s skin tone and the keloid’s maturity. Discoloration is caused by changes in melanin production and blood flow. Laser therapy or topical lightening agents can help improve skin tone uniformity.

Growth Over Time

Growth over time is seen in about 80% of keloid cases. Keloids can continue to grow for months or even years after the initial injury due to ongoing collagen overproduction. Monitoring the keloid’s size and seeking early treatment can help manage and potentially limit further growth.

Sensitivity to Touch

Sensitivity to touch is reported by about 30% of keloid patients. This symptom is due to nerve involvement and inflammation within the keloid. Patients may experience discomfort or pain when the keloid is touched. Protective measures, such as padding or avoiding direct pressure, can help reduce sensitivity.

Diagnostic Evaluation of Keloid Scars

Keloid diagnosis is primarily clinical, based on the lesion’s appearance and history. A healthcare provider will assess the keloid’s size, shape, location, and symptoms like pain or itching. Patient history is crucial, as it provides insight into the keloid’s development and any previous treatments. While a physical exam and patient history are often sufficient, additional diagnostic evaluations may be necessary to confirm the diagnosis or rule out other conditions.

Biopsy

A biopsy involves taking a small sample of keloid tissue for examination under a microscope, typically performed under local anesthesia. The biopsy helps differentiate keloids from other skin conditions, such as hypertrophic scars or skin tumors. It is important for confirming the diagnosis when the clinical presentation is atypical.

Results that Indicate Keloid

Biopsy results indicating a keloid will show thickened collagen bundles and a lack of normal skin architecture. The presence of excessive fibroblasts and collagen fibers confirms the diagnosis. If the biopsy results are negative for keloid, it may suggest another type of scar or skin condition, requiring further evaluation and alternative treatments.

Dermatoscopy

Dermatoscopy is a non-invasive imaging technique that uses a dermatoscope to magnify the skin’s surface. This tool allows healthcare providers to examine the keloid’s color, pattern, and vascular structures. Dermatoscopy is useful for distinguishing keloids from other pigmented lesions and for monitoring treatment progress.

Results that Indicate Keloid

Dermatoscopic findings in keloids typically include a homogeneous pattern with a pinkish hue and white streaks, representing collagen bundles. The absence of atypical pigmentation or irregular vascular patterns supports a keloid diagnosis. If dermatoscopy results are inconclusive, further diagnostic tests or a biopsy may be warranted.

Ultrasound

Ultrasound imaging uses sound waves to create images of the keloid and surrounding tissues. This test provides information about the keloid’s depth, density, and vascularity. Ultrasound is particularly useful for assessing larger keloids or those located in sensitive areas, as it is non-invasive and does not involve radiation.

Results that Indicate Keloid

Ultrasound results indicating a keloid will show a hypoechoic (dark) area with increased vascularity compared to normal skin. The presence of thickened collagen layers and altered tissue structure supports the diagnosis. If ultrasound findings do not align with a keloid diagnosis, further investigation may be needed to explore other conditions.

MRI

Magnetic Resonance Imaging (MRI) uses magnetic fields and radio waves to produce detailed images of the keloid and surrounding tissues. MRI is particularly beneficial for evaluating deep or complex keloids that are not easily assessed by other imaging techniques. It provides comprehensive information about the keloid’s size, shape, and impact on adjacent structures.

Results that Indicate Keloid

MRI results indicating a keloid will show a well-defined mass with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. The presence of dense collagen and fibrous tissue confirms the diagnosis. If MRI results are negative for keloid, alternative diagnoses should be considered, and further testing may be necessary.

CT Scan

Computed Tomography (CT) scans use X-rays to create cross-sectional images of the body. CT scans are less commonly used for keloid evaluation but can be helpful in assessing keloids that affect deeper structures or are located in complex anatomical areas. CT scans provide detailed information about the keloid’s density and its relationship with surrounding tissues.

Results that Indicate Keloid

CT scan results indicating a keloid will show a dense, well-circumscribed mass with homogeneous attenuation. The presence of thickened collagen and fibrous tissue supports the diagnosis. If CT scan findings do not indicate a keloid, further evaluation may be necessary to explore other potential conditions.

Histopathological Analysis

Histopathological analysis involves examining the keloid tissue under a microscope to assess its cellular structure. This analysis provides detailed information about the keloid’s composition, including collagen density and fibroblast activity. Histopathological analysis is crucial for confirming the diagnosis and differentiating keloids from other skin lesions.

Results that Indicate Keloid

Histopathological results indicating a keloid will show thickened collagen bundles, increased fibroblast activity, and a lack of normal skin architecture. The presence of excessive collagen deposition confirms the diagnosis. If histopathological findings are negative for keloid, alternative diagnoses should be considered, and further testing may be necessary.

Patch Testing

Patch testing involves applying small amounts of potential allergens to the skin to identify any allergic reactions. While not directly used to diagnose keloids, patch testing can help identify any underlying allergic reactions that may contribute to keloid formation or exacerbate symptoms.

Results that Indicate Keloid

Patch testing results do not directly indicate a keloid diagnosis. However, identifying allergens that trigger skin reactions can help manage symptoms and prevent further keloid development. If patch testing results are negative, it suggests that allergens are not contributing to the keloid’s formation or symptoms.

Scar Assessment Tools

Scar assessment tools, such as the Vancouver Scar Scale, are used to evaluate the severity and characteristics of keloids. These tools assess factors such as pigmentation, vascularity, pliability, and height. Scar assessment tools are useful for monitoring treatment progress and determining the effectiveness of interventions.

Results that Indicate Keloid

Scar assessment results indicating a keloid will show high scores in areas such as height, firmness, and pigmentation. These results help quantify the keloid’s severity and guide treatment decisions. If scar assessment results do not align with a keloid diagnosis, further evaluation may be necessary to explore other conditions.

Photography

Photography involves taking standardized images of the keloid to document its appearance and monitor changes over time. This tool is useful for tracking treatment progress and providing visual evidence of the keloid’s response to interventions. Photography is a non-invasive and cost-effective method for evaluating keloids.

Results that Indicate Keloid

Photographic results indicating a keloid will show a raised, firm lesion with distinct borders and possible discoloration. These images help track changes in size, color, and texture over time. If photographic results do not support a keloid diagnosis, further evaluation may be necessary to explore other conditions.

What if All Tests Are Negative but Symptoms Persist?

If all tests are negative for keloid but symptoms persist, it is important to consult with a healthcare provider for further evaluation. Persistent symptoms may indicate another underlying condition that requires attention. A comprehensive assessment, including a review of medical history and additional diagnostic tests, may be necessary to identify the cause of the symptoms and determine appropriate treatment options.

Treatment Options for Keloid Scars

Medications for Keloid Treatment

Triamcinolone

Triamcinolone is a corticosteroid commonly used to reduce inflammation and suppress the immune response in keloid scars. It is typically injected directly into the keloid to help flatten and soften the scar tissue.

As a first-line treatment, triamcinolone is administered through intralesional injections every 4 to 6 weeks, depending on the size of the keloid and how well it responds to treatment. This therapy is often combined with other treatments to enhance effectiveness.

Over the course of several weeks to months, patients may notice a reduction in the size and thickness of the keloid. Additionally, symptoms such as itching and discomfort may improve.

5-Fluorouracil

5-Fluorouracil, a chemotherapy agent, is used to treat keloids by inhibiting the growth of fibroblasts, which are responsible for excessive scar formation.

It is often combined with corticosteroids like triamcinolone and injected directly into the keloid, typically on a weekly basis for several weeks.

Patients may observe a decrease in keloid size and symptoms over a few months, though multiple treatment sessions are usually required.

Dexamethasone

Dexamethasone is another corticosteroid that helps reduce inflammation and scar tissue formation in keloids. It can be used alone or in combination with other treatments.

Similar to triamcinolone, dexamethasone is administered via intralesional injections and is often reserved for cases where other corticosteroids have not been effective.

Patients can expect improvements in the appearance and symptoms of the keloid over several weeks, with repeated treatments as necessary.

Silicone Gel

Silicone gel is a topical treatment that hydrates the skin and helps reduce the size and discoloration of keloids. It is available in both gel form and as silicone gel sheets.

Applied directly to the keloid, silicone gel is often a first-line treatment due to its non-invasive nature. It is typically used daily for several months.

With consistent application, patients may notice gradual improvements in the texture and color of the keloid.

Interferon

Interferon is a protein that modulates the immune system and reduces fibroblast activity in keloid scars.

Usually reserved for more severe keloids, interferon is administered through injections directly into the scar and is often combined with other therapies.

Patients may experience a reduction in keloid size and symptoms over several weeks to months, though individual responses can vary.

Verapamil

Verapamil, a calcium channel blocker, works by reducing collagen production in keloid scars.

It is typically administered via intralesional injections and may be combined with other treatments for keloids that are resistant to standard therapies.

Patients can expect a gradual reduction in keloid size and symptoms over several months, with repeated treatments as needed.

Imiquimod

Imiquimod is an immune response modifier that helps reduce keloid formation by stimulating the body’s immune system.

This topical cream is often applied after surgical excision to prevent the keloid from returning. It is typically used several times a week for several months.

With consistent use, patients may experience a reduction in keloid recurrence and size.

Other Keloid Scar Removal Options

Cryotherapy

Cryotherapy involves freezing the keloid tissue with liquid nitrogen to reduce its size and thickness.

This procedure is often used for smaller keloids and can be combined with other treatments, such as corticosteroid injections, for enhanced results.

Patients may notice a reduction in keloid size and symptoms over several weeks, though multiple sessions may be required.

Radiation Therapy

Radiation therapy uses targeted radiation to shrink keloids and prevent them from returning after surgical removal.

This treatment is typically reserved for more severe keloids that have not responded to other therapies. It is often administered shortly after surgical excision.

Patients can expect a reduction in keloid recurrence and size, though individual responses may vary.

Surgical Excision

Surgical excision involves removing the keloid scar tissue through surgery.

This procedure is often used for larger keloids that have not responded to other treatments. It is usually combined with therapies like radiation or corticosteroid injections to reduce the risk of recurrence.

While patients may experience a reduction in keloid size and symptoms, there is a possibility that the keloid could return.

Improving Keloid Scars and Seeking Medical Help

Home remedies can complement medical treatments for keloids. Options such as aloe vera, tea tree oil, apple cider vinegar, honey, silicone gel sheets, vitamin E oil, coconut oil, lemon juice, garlic, and turmeric may help soften and lighten scar tissue. These natural remedies can be applied topically, often daily, to improve the appearance of keloids.

While home remedies may offer some relief, it is important to seek medical attention for persistent or worsening keloids. Telemedicine provides a convenient way to consult with healthcare professionals from the comfort of your home. Our primary care telemedicine practice can guide you through available treatment options and help develop a personalized management plan.

Living with Keloid Scars: Tips for Better Quality of Life

Living with keloid scars can be challenging, but there are steps you can take to improve your quality of life. Protect your skin from injury and sun exposure, as these can worsen keloid formation. Use gentle skincare products and avoid harsh chemicals that may irritate the skin. Stay informed about your condition and treatment options, and maintain regular communication with your healthcare provider to monitor your progress and adjust your treatment plan as needed.

Conclusion

Keloids are a common skin condition characterized by excessive scar tissue formation. Early diagnosis and treatment are essential for managing keloids effectively and preventing complications. Our primary care telemedicine practice is here to support you in understanding your condition and exploring the best treatment options for keloid scars. Don’t hesitate to reach out for a consultation and take the first step toward improving your skin health.

James Kingsley

Learn More