Keloids are raised overgrowths of scar tissue that occur at the site of a skin injury (Fig 1). They occur where trauma, surgery, blisters, vaccinations, acne or body piercing have injured the skin. Less commonly, keloids may form in places where the skin has not had a visible injury. Keloids differ from normal mature scars in composition and size. Some people are prone to keloid formation and may develop them in several places.
What causes Keloids?
No one knows why keloids form. Although most persons never form keloids, others develop them after minor injuries or even after insect bites or after acne bumps resolve.
Keloids may form on any part of the body, although the ears, upper chest, upper back, and shoulders are especially prone to keloid formation. Persons with darker skin form keloids more easily than those with lighter skin, although anyone can form a keloid. Keloids never turn into skin cancer.
Keloids can be difficult to treat. Keloids are scar tissue, and it is important to realize that you can never change a scar back into normal skin.
The goal in treating keloids is to
- diminish any pain,
- diminish any itching, and
- flatten the lesion so that it is more like the surrounding normal skin.
The most common type of treatment include:
1) The injection of steroid into the keloid
The doctor has decided to start your treatment by giving an injection called intralesional corticosteroid injection. Corticosteroids are hormones secreted by the adrenal cortex or synthetic analogues of these hormones. They have anti-inflammatory, antipruritic (anti-itch) and antisuppressive actions. The injection is given directly into the keloids.
Depending on the size of your keloids, you may require multiple injections per session, as well as repeated treatment sessions, usually at monthly intervals.
Cryotherapy consists of applying liquid nitrogen to the keloid.
You may experience discomfort, itching and pain during and even after the treatment is given.
If you are still experiencing pain when you are at home, you may use a cold compress - by using an ice-pack and leaving it on for a while; or you can take a mild painkiller such as paracetamol if you are not allergic to it.
If you are fearful of injections, or feel that you have a low threshold to pain, please inform your doctor or the attending nurse. There are measures that can be undertaken to reduce the discomfort including the use of topical anesthetic creams, which may take an hour or so to be effective.