Keloid Formation
Scar tissue that grows beyond the original wound
Quick Facts
- Type: Skin scarring condition
- Key feature: Grows beyond the wound's borders
- Common sites: Earlobes, chest, shoulders, upper back
- Outlook: Benign but can recur after removal
Overview
A keloid is a type of raised scar that forms when the skin overproduces collagen during healing. Unlike an ordinary or hypertrophic scar, a keloid grows beyond the edges of the original wound and spreads into surrounding healthy skin. Keloids can keep growing for months or years and often do not shrink on their own.
Keloids are benign, meaning they are not cancerous, but they can be itchy, tender, or cosmetically distressing. They form most often on the earlobes, chest, shoulders, and upper back, and they are more common in people with darker skin tones. Treatment can flatten and shrink keloids, though they have a tendency to return.
Symptoms
Keloids have distinctive features:
- A raised, firm, rubbery, or shiny growth that extends past the original wound
- Color ranging from pink and red to darker than the surrounding skin
- Itching, tenderness, or a prickly sensation, especially as it grows
- Gradual enlargement over weeks, months, or longer
- Discomfort or restricted movement if located over a joint
The hallmark that separates a keloid from a hypertrophic scar is its growth beyond the boundaries of the original injury.
Causes
Keloids develop when the skin's healing response overshoots and lays down excess scar tissue. Almost any skin injury can trigger a keloid in a susceptible person, including:
- Surgical incisions and cuts
- Ear and body piercings
- Burns
- Acne and chickenpox scars
- Vaccination or injection sites
- Tattoos
Sometimes keloids form with little or no obvious injury. The exact reason some people make keloids and others do not is not fully understood, but genetics play a strong role.
Risk Factors
- Darker skin tones
- A personal or family history of keloids
- Younger age, often between 10 and 30 years
- Wounds in keloid-prone areas such as the earlobes, chest, and shoulders
- Repeated skin injury or inflammation in the same area
Diagnosis
A keloid is usually diagnosed by appearance and history. The defining clue is scar tissue that has grown beyond the borders of the original wound.
- Skin examination of the size, shape, and spread of the scar.
- Distinguishing from a hypertrophic scar, which stays within the wound edges.
A biopsy is rarely needed but may be done if the diagnosis is unclear.
Treatment
Keloids can be stubborn, and combining treatments often works best. Options include:
- Corticosteroid injections: A common first-line treatment to flatten and soften the keloid and reduce itching.
- Silicone gel or sheets and pressure therapy: Used to help shrink keloids, including pressure earrings after earlobe keloid removal.
- Cryotherapy: Freezing small keloids.
- Laser therapy: To improve color and flatten the scar.
- Surgical removal: Often combined with steroid injections or other treatments afterward, because surgery alone frequently leads to a larger keloid returning.
Because keloids commonly recur, treatment usually focuses on shrinking and controlling them rather than guaranteeing they will never come back.
Prevention
- If you are keloid-prone, avoid elective skin procedures such as non-essential piercings and tattoos
- Treat acne early to limit scarring
- Care for any wound carefully and ask about silicone sheets or pressure therapy for at-risk areas
- Tell your surgeon about a keloid history before any planned procedure
- Avoid further injury or irritation to keloid-prone skin
When to See a Doctor
See a dermatologist if you have a scar that:
- Is growing beyond the original wound
- Is itchy, painful, or tender
- Limits movement or causes cosmetic concern
- Is returning after previous treatment
Early treatment can make keloids easier to control.
Frequently Asked Questions
What causes keloids to form?
Keloids form when the skin overproduces collagen during healing, causing scar tissue to grow beyond the original wound. Almost any skin injury, including cuts, surgery, piercings, burns, and acne, can trigger them in susceptible people. Genetics and skin tone strongly influence the risk.
How are keloids different from other scars?
A keloid grows past the borders of the original wound into normal skin and often keeps enlarging. Ordinary and hypertrophic scars stay within the wound boundaries and usually fade over time. This spreading growth is the defining feature of a keloid.
Can keloids be removed permanently?
Keloids can be flattened and shrunk, but they often return, especially after surgery alone. That is why treatment usually combines methods such as steroid injections, silicone, pressure therapy, or laser. The goal is to control the keloid rather than guarantee it never comes back.
Who is most likely to get keloids?
Keloids are more common in people with darker skin tones, those with a personal or family history of keloids, and people aged roughly 10 to 30. Wounds on the earlobes, chest, shoulders, and upper back are especially prone to forming them.
References
- American Academy of Dermatology Association. Keloids: Diagnosis and treatment.
- Mayo Clinic. Keloid scar.
- MedlinePlus, U.S. National Library of Medicine. Keloids.
- British Association of Dermatologists. Hypertrophic and keloid scars.