Keloid Scars: How to Treat a Wound That Doesn't Know It Has Healed
A keloid scar is a type of scar that doesn’t know when to stop growing. Although the causes of this scarring is still unknown, effective treatment options do exist.
Plastic surgeons and dermatologists commonly diagnose and treat keloids. We spoke with two leading experts to help us understand everything about keloid scars, along with the treatment options that provide the best results.
- 1 What are keloid scars?
- 2 Keloid scars vs. hypertrophic scars
- 3 Risk factors for keloid scar formation
- 4 Is there a genetic component involved?
- 5 Keloid scars and skin cancer
- 6 Keloid scar treatment options
- 7 Recurrence rates
- 8 How long does it take to treat keloid scars?
- 9 New treatment options on the horizon
- 10 Keloid Scars: Quick Facts
What are keloid scars?
Keloid formation can occur due to any type of skin injury, where the scar can end up larger than the original wound or problem. Keloids don’t pose any kind of health issue, but given they can be very unattractive, there are options to have them removed.
“A scar is an important and integral part of wound healing and is your body’s natural response to injury of the skin,” says San Diego plastic surgeon Dr. Gilbert Lee. “The vast majority of scars heal in a cosmetically acceptable manner. However, when the scarring process is too vigorous, the over-healing process results in a hypertrophic scar or keloid.”
Instead of forming a neat scar that is level with the surface of your skin, keloid scar tissue is “raised, rubbery, and usually a firm growth that overtakes the wound and continues to develop beyond the wound boundaries,” adds Dr. Lee.
Keloid scars can occur anywhere on the body but they are more common on the upper chest, shoulders, abdomen, upper back and ears. They can appear directly after an injury or procedure or in some cases can develop months later.
Keloids have a tendency to enlarge progressively over time. And if an individual is susceptible, they can also have multiple keloids.
Keloid scars vs. hypertrophic scars
Hypertrophic and keloid scars can look similar in some cases but they are not the same.
“Hypertrophic scars look like a raised, reddish lump on the skin, but do not grow beyond the boundary of the injured site,” informs Dr. Lee. “In contrast, keloids proliferate beyond the boundaries of the initial skin injury and often continue to grow over time. And keloids are usually very thick and appear as red or purple colored lesions.”
Risk factors for keloid scar formation
Keloid formation can occur from trauma, surgical excision, burns, body piercing, acne scars or any other skin injuries. Infections and hormonal dysfunctions have also been proposed as triggers in some people. Though not as common, chickenpox scars can lead to keloid scarring, too.
Though anyone can get them, they are more prevalent between the ages of 10 and 30 years. People with darker skin tones form keloids more frequently than those with lighter skin.
Santa Monica dermatologist and professor of dermatology Dr. Tanya Kormeili suggests that women are more at risk from c-section, piercings – particularly ear piercings – and other forms of surgery. People of Asian and African American descent are at greatest risk of developing keloid scars on ears.
Is there a genetic component involved?
Though keloids are still poorly understood, there is strong evidence to suggest that genetics influence their formation. If other family members have keloid scars, then you may have an increased risk developing keloid scarring as well. There is also evidence to suggest that keloids are more common in twins than the population at large.
Keloid scars and skin cancer
In many ways keloids are a type of skin tumor, as they have a tendency to continue to grow and become larger and tumorous in nature. In the majority of cases they are benign – meaning, that they are not skin cancerous. There have been some cases of secondary tumors developing on top of keloid scars, though this is extremely rare.
The images below present one such case, a keloid scar on the ear from first appointment through treatment. Using injections and a pressure earring, which at first made the keloid worse, the treatment made the keloid scarring recede for some months before returning with extremely rapid growth.
On examination, basal cell carcinoma (skin cancer cells) were identified growing from within the keloid.
If you notice strange moles and freckles, keloid scarring, or any kind of skin abnormality that looks suspicious or is growing or changing rapidly, always seek professional medical advice and have a skin biopsy if required.
Keloid scar treatment options
Though keloid scarring can be frustrating due to its constant growth, viable treatment options exist and can help to manage this issue. According to Dr. Lee, the treatment options available are as follows:
Silicone gel sheeting or semi-occlusive silicone
Using topical silicone gel is one of the main non-surgical methods for keloid scarring treatment. Clinical studies have shown that silicone products reduce inflammation associated with scar formation.
Radiation therapy has proven beneficial in decreasing the activity of cells that form scar tissue. For those with recurrent or particularly dramatic keloid scarring, a low dose radiation therapy in conjunction with scar revision may prevent keloid recurrence.
This treatment for keloid scarring works by applying constant pressure to surface blood vessels and eventually causes the scar to flatten and become softer. “A compression bandage prevents overstretching of the area of the wound as a result of frequent movement, which can promote the development of excessive scar tissue,” says Dr. Lee.
Corticosteroid injections such as Kenalog, which contains triamcinolone, are administered via local injection directly into the scar formation to help soften tissue, reduce inflammation and minimize the chance of scarring. Only small amounts are injected at a time, which can be quite painful, and repeated treatments are usually necessary. Steroid injections have been shown to flatten keloid scars from 50 to 100 percent.
Scar revision surgery
This is reserved for scars that have failed to improve with nonsurgical treatments. Surgical removal of the scar remains one of the most effective and immediate treatments for scarring.
Further to the above options, Dr. Kormeili suggests laser treatments can also be used. “Laser treatment uses light to reduce the inflammation and kill off the extra blood vessels that feed the keloid,” says Dr. Kormeili.
When pulsed dye laser and long-pulsed Nd:YAG laser were split-scar tested on twenty patients, both treatments were shown to be equally effective. The patients had six treatments at one month intervals.
Liquid nitrogen, known as cryotherapy, has been studied as a keloid scarring treatment. The procedure works by freezing the scar tissue through a freeze and thaw cycle over several treatments. Cryotherapy is sometimes combined with steroid injections.
Though there has been some success shown in the flattening of keloid scars with cryotherapy, overall, it’s not a commonly used treatment option.
Verapamil, used as a topical cream applied to keloid scars after steroid injections has been shown to prevent rebound scarring. However, there are mixed results as to the effectiveness, some studies showing no benefit of Verapamil between those who do or don’t use it.
“Keloids can be very difficult to treat and have a tendency to reappear even after scar removal,” says Dr. Lee. That’s why it’s important to see a trained professional who understands how to treat keloids effectively.
Dr. Kormeili warns that in most cases non surgical methods are best for keloid removal, saying, “as soon as the keloid is “cut” there is a signal to the skin to “start the wound healing process,” which in turn may make an even bigger keloid.”
Dr. Lee informs that where scar revision surgery is used, it is usually combined with steroid injections or radiation therapy to minimize the chance of the keloids recurring. Radiation therapy has been demonstrated as the most effective treatment in reducing recurrence rates.
How long does it take to treat keloid scars?
Dr. Kormeili suggests, “combination treatments are the best as they work synergistically to reduce inflammation and thickness of the keloid.”
The treatment of keloids will take a series of treatments over several months, which will depend on how aggressively the keloid is growing. Your dermatologist or surgeon will advise on the best treatment plan to suit your individual skin condition and situation.
New treatment options on the horizon
There is currently a wide range of scientific research being conducted investigating various medications that may inhibit keloid growth. Preliminary evidence using Botox injections shows it may help reduce the formation of keloids by decreasing the tension around the wound edges.
Ultraviolet light is being explored for its role in increasing the activity of enzymes in collagen. And various topical creams are being inspected more closely. In time, new treatments will no doubt emerge that will hopefully provide better outcomes for those who are susceptible to keloid lesions.
Keloid Scars: Quick Facts
Scars are formed as part of the healing process when wounded tissue expresses collagen through a process called collagen synthesis. This eventually results in the formation of an inelastic mass with a different texture and quality than the unwounded tissue that surrounds it. In the case of a keloid scar, this process can take on a life of its own and last years. As a result, keloid scars are more pronounced than most other scars.
Where? Where there’s not much fat
According to the American Society of Plastic Surgeons (ASPS), keloid scars are most likely to form in areas where there is not much underlying fatty tissue, such as the face, ears, neck, chest or shoulders.
Not the same as hypertrophic scars
Hypertrophic scars look similar but do not grow beyond the borders of the injured area. Keloids, on the other hand, spread beyond the boundaries of the initial skin injury and often continue to grow over time. Keloids are also usually very thick — thicker than hypertrophic scars.
Family history plays a role
There is strong evidence to suggest that family history and genetics influence the formation of keloid scars. If other family members have them, you may also inherit them.
So does skin tone
People with darker skin tones develop keloid scars more frequently than those with lighter skin, which is why African-American, Latinx, and Hispanic patients are more likely to develop them than certain other ethnicities. People of Asian or African-American ethnicity are at greatest risk for developing keloid scars on the ears.
There are treatments
Combining two or more of the following treatments over several months is usually the most effective way to treat keloid scars:
- Silicone gel sheeting or semi-occlusive silicone
- Radiation therapy
- Pressure dressing
- Steroid injections
- Scar revision surgery
- Laser therapy
- Liquid nitrogen
- Verapil (topical cream)
- Pressure therapy
Surgery is also an option in some cases. And in the future, Botox injections, ultraviolet light treatments, topical creams and other treatments may expand patients’ options. Speak to a board certified dermatologist or plastic surgeon to learn more about keloid scar treatment.
Updated June 2017, Zwivel Team
Ask a Cosmetic Doctor on Zwivel
Got a question about a cosmetic treatment? With over 2,000 doctor answers and counting, the Zwivel forum is the best place to get expert professional opinions.
Hundreds of questions have already been answered: