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Is a Keloid Just A Scar or Something More?

Scarring whether it be subtle or more noticeable can be frustrating and cosmetically displeasing. The reality is that scarring may not always look the same on every person and/or on different body parts. Some scars may have an indentation in the skin and may resemble a pox-like scar. While other scars may cause thickening and overgrowth of the scar tissue.

When this overgrowth of the scar tissue remains in the boundary of the scar itself this is called hypertrophic scarring. However, when the scarring goes beyond the boundaries of the scar itself this is referred to as a keloid.

Though keloids may occur in all skin types, they are most commonly found in darker skin types, such as SE Asian, Latin American, Middle Eastern and African.

What triggers keloid formation?

Keloids may occur on the skin for a number of reasons:

(1) Simple bug bites

(2)Piercings (most commonly ear)

(3) Acne scarring

(4) Surgical Wound(s)

Cultural and Historical Influence:

Keloidal scarring had been incorporated in select rural African and SE Asian tribes in a process called scarification wherein deliberate scarring is performed through burning, branding, etching, scratching of the skin. Small studies have evaluated the genetic component to keloid scarring by looking at the cultural practice of scarification and found that there is evidence for a genetic link to keloid formation.

How are keloids diagnosed?

Keloids are diagnosed by a dermatologist by clinical examination. They appear as firm (often darker in pigmentation from the surrounding skin) growths. At times, keloids may be itchy and less frequently tender. If it is unclear if the scar is truly a keloid, a biopsy of the growth may be performed by the dermatologist.

How can we treat keloids?

There are various types of treatments for keloids; however, the most important thing is PREVENTION. Taking the steps to minimize scar formation (i.e. acne treatment, pre-treatment with intralesional steroid before and/or directly after a surgical procedure or piercing, etc.) is essential.

(1) Topical Steroids- May be used to help control itching

(2) Intralesional steroids- Performed by a dermatologist through injection of a steroid into the keloid itself.

(3) Injection of Methotrexate - This has been shown to be helpful to reduce the appearance of the keloid.

(4) Topical irritants- Efudex cream, Topical Retinoids (help with improving hyperpigmentation and scar formation)

(5) Medicated tape (frequently containing topical steroid)

(6) Surgical excision (performed by dermatologist) often followed by a series of intralesional steroid injections

(7) Laser resurfacing

(8) Cryotherapy/Cryodestruction - Freezing the keloid with liquid nitrogen

If you are experiencing keloids, it is important to schedule an appointment with your dermatologist to discuss the treatment appropriate for you.

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