Skin Keloids

Definition of a Keloid
Keloids are excessive scar tissue overgrowths at the sites of healed skin injury that extend beyond the original scar margins. They can be described as scars that do not know when to stop growing. Initial signs of keloid formation may be observed a few weeks following the injury. These heavy scars are also referred to as cheloids or keloid scars, and sometimes are mistakenly called hypertrophic scars. Keloids are tough, shiny or rubbery nodules that rise above the rest of the skin surface and can vary in color form pink to red to brown. Upon tanning, these scars may become darker than the rest of the skin and remain highly pigmented. Keloids are mostly found on earlobes, upper back, chest, and shoulders. The scars grow in a claw-like manner and tend to enlarge progressively. Some keloids flatten and become less noticeable over time but others may continue to grow indefinitely. They can be accompanied by sharp pain, severe itchiness, tenderness and increased sensitivity depending on the patient. Besides cosmetic and physical disfigurement, keloids cause discomfort and may lead to limited mobility when located over a joint.

Skin Keloid Symptoms

1. Keloids are a raised pink, red or brown nodules that develop at the site of injury
2. Keloid formed scar tissue projects above the surface of the skin
3. Keloids may grow beyond the original wound area
4. Keloid scars may be itchy and painful
5. Keloids may ulcerate if they get infected

Causes of Skin Keloids
These firm fibrotic lesions usually occur at any place on the skin during healing of deep wounds but may also arise spontaneously at sites of piercing, vaccination, surgical incisions, acne, burns, chickenpox scarring or a simple scratch. Keloids may form at the sites of constant skin friction and tension and as a result of wound infections. Wounds subjected to prolonged inflammation and repeated trauma are at a risk for developing abnormal scars. However, it is not fully understood how and why keloids form in one people and not the other. Changes in cellular growth and repair regulations may be related to keloid formation. In skin healing process, skin cells and connective tissue cells (fibroblasts) begin multiplying to close the wound. In keloid scars, atypical fibroblasts deposit excess of extracellular matrix components, especially collagen, even after the wound is closed. This abnormality leads to thick overgrowth of collagen and other extracellular matrix components that form nodules in the deep dermal portion of the scar. The excess of scar tissue forms a keloid that projects above the surface of the skin.

Epidemiology

Keloids are found only in humans and occur in about 5-15% of population. While most people never develop keloids, in people prone to excessive scar growths, even minor injuries such as insect bites or pimples may lead to keloids. Men and women are equally affected. The average age at onset is 10-30 years with children under 10 years and adults over 65 years being less likely to develop keloids. African, Hispanic and Asian populations have higher frequency of keloid occurrences. Overall, people with darker pigmented skin are 15 times more susceptible to form keloid scars. There also has been shown some degree of genetic predisposition in keloid scar formation; thus, tendency for keloid development can be passed down from generation to generation.

Keloids versus Hypertrophic Scars

Sometimes keloids are mistaken for hypertrophic scars. After skin heals, usually a flat scar is left at the site of an injury. In some cases, the scar tissue becomes thickened, or hypertrophic. Hypertrophic scars do not get as big as keloids and are limited to the area of the wound. They may fade over time.

Keloids, on the other hand, are less common and may start developing some time after the injury. Ability of keloids to extend beyond the wound area and grow into the surrounding areas that were not injured before distinguishes keloids from hypertrophic scars.

Keloid Tests and Exams
Keloid diagnosis is made on the basis of physical examination of the scar and surrounding skin. Obtaining a skin biopsy may be necessary to confirm the diagnosis and reject a possibility of other skin growths such as tumors. A keloid should be examined by a physician or a surgeon to decide upon the optimal course of treatment.

Skin Keloid Before and After Photos
Skin Keloid Treatment Options

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Dr. Oleh Slupchynskyj is Double Board Certified in Facial Plastic and Reconstructive Surgery and in Otolaryngology – Head and Neck Surgery. He is also a clinical instructor of Facial Plastic Surgery at the New York Eye and Ear Infirmary, St. Vincent’s Hospital has affiliations with St. Barnabas Hospital in NJ. An independent health consumer council recently voted him one of Americas Top Surgeons.Learn more about Dr. Slupchynskyj