Conditions & Treatments

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 piercings 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. They can itch and cause sharp, shooting pains when pressed.

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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 resolved.

Keloids may form on any part of the body, although the ears, jawline, neck, upper chest, upper back and shoulders are especially prone to keloid formation. Although anyone can form a keloid, persons with darker skin form them more easily than those with lighter skin, and may develop them in several places. Keloids never turn into skin cancer.

Multiple keloids shown on the trunk

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 no​rmal skin.

The goal in treating keloids is to​

  1. diminish any pain,
  2. diminish any itching, and
  3. 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 have anti-inflammatory, anti-pruritic (Anti-itch) and suppressive 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.
    • 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 anaesthetic creams, which may take an hour or so to be effective.
  2. Cryotherapy
    • Cryotherapy consists of applying liquid nitrogen to the keloid.
    • Repeated treatment sessions are usually necessary, usually at monthly intervals.
  3. Silicone sheets and gel formulation
    • The mechanism via which silicone products exert anti-scarring effect is unknown, but may be related to occlusion and hydration of the uppermost layer of the skin. You should wear silicone gel sheets over the scars for at least 12 hours daily for 2-3 months. Silicone gel should be applied on the scar twice daily for 2-3 months.
  4. Surgical excision
    • This may be useful in some patients, such as those who have failed conservative therapy and those with earlobe keloids.
    • Surgical removal of keloids is associated with a high recurrence rate, but use of adjunctive perioperative therapies such as intralesional corticosteroids may help to reduce the recurrence rate.
    • Less commonly used methods in the treatment of keloids include the use of radiation and laser therapy.

Potential side effects of the common treatment for keloids

  • Injection of steroid into keloid may cause several adverse side effects such as telangiectasia (capillary dilation), thinning (atrophy) of the skin and subcutaneous fat, pigmentary changes (hypopigmentation or hyperpigmentation), steroid acne, skin infection and sometimes skin ulcer.
  • Cryotherapy may cause 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. Cryotherapy may also cause blistering, pigmentary changes (hypopigmentation or hyperpigmentation), skin infection and sometimes delayed healing.