Keloid scar

Symptoms

A keloid scar may form after an injury to the skin. Sometimes it might take months or years for the scar to develop. Symptoms can include:

• Thick scarring typically on the ear, shoulder, upper back or chest.
• Shiny, hairless, lumpy, raised skin that continues to grow for weeks to months. Some keloids may grow for years.
• Red, brown or purple coloring, depending on the skin's color.
• Itchiness, pain or a feeling of burning on the keloid scar.

A keloid's size can range from just a few millimeters to 700 millimeters or more. That's smaller than the size of a pea to larger than the size of a football. The texture of a keloid scar can vary, from soft and doughy to firm and rubbery.

A keloid scar is similar to another type of scar, called a hypertrophic scar. Both are unusual scars that may form after a skin injury. But a keloid scar grows beyond the area where the skin was injured. A hypertrophic scar stays within the borders of the original injury. Most hypertrophic scars go away with treatment and don't come back. They also may go away on their own without treatment. Keloids won't go away without treatment. And although treatment may be helpful for keloids, treatment doesn't always work. Keloid scars can come back after treatment.

When to see a doctor

Early treatment can help limit a keloid's growth. Make an appointment to see your healthcare professional soon after you notice a keloid scar. If you want to treat a keloid scar that you've had for a while or if a keloid is causing symptoms such as pain or itchiness, you may need to see a doctor who specializes in skin conditions, called a dermatologist.

Risk factors

Risk factors for keloid scars include:

• Having brown or Black skin. Keloid scars are more common in people with brown or Black skin. The reason for this is not known.
• Having a personal or family history of keloid scars. Keloids often run in families. So it's possible that the tendency to develop keloid scars may be inherited. If you've had one keloid, you're at higher risk of getting more.
• Being under 30. You're more likely to develop a keloid scar if you're between the ages of 10 and 30.

Prevention

If you're prone to developing keloid scars, take the following steps to help prevent them.

Protect skin from injury

Try to avoid injuring your skin. Avoid body piercings, tattoos and elective surgeries. Even minor injuries can cause a keloid to form. Examples include ingrown hairs, cuts and scratches.

If you decide to have surgery, be sure that your surgeon knows about your tendency to develop keloids. There are surgical techniques that lower the risk of developing keloids at the surgical site. After surgery, ask your surgeon how to care for the wound. Follow those directions carefully.

Practice good wound care

If you have an injury to your skin, keep the wound clean and moist. Gently wash the area with mild soap and water. Put a thin layer of petroleum jelly (Vaseline, Aquaphor, others) or another ointment on the wound. Apply the ointment again throughout the day as needed.

Your healthcare professional may suggest that you put a pressure pad or a silicone gel pad on the wound while it's healing. You may need to wear the pad for several months or more.

Putting pressure earrings on the earlobes after an ear piercing helps prevent keloid scars.

Treatment

Keloid scar treatments include the following options. Some people only need one of these treatments, while others may need more than one. Even after successful treatment, keloids can grow back. They may come back bigger than before. Or new keloid scars may develop.

Pressure therapy

For new keloid scars, the first treatment may be compression dressings made from stretchy fabric or other materials. Pressure therapy also is used after surgery that's done to remove keloid scars. The goal is to make a keloid scar smaller or prevent a new scar from forming by putting pressure on the wound as it heals. For the treatment to work, most people need to wear the dressings for 12 to 24 hours a day for 4 to 6 months.

Injected medicine

If you have a small keloid scar, your healthcare professional may try to flatten it by injecting the scar with cortisone or another steroid. You'll likely need monthly injections for up to six months before the scar flattens. Possible side effects of corticosteroid injections include skin thinning, spider veins and a permanent change in skin color.

Laser treatment

Large keloids can be flattened with pulsed-dye laser treatment. This treatment also is useful for easing itchiness and fading keloid scars. Pulsed-dye laser therapy is given over several sessions with 4 to 8 weeks between sessions. Your healthcare professional may suggest combining laser therapy with cortisone injections. Possible side effects, which are more common in people with brown or Black skin, include a change in skin color, blistering and crusting.

Radiation therapy

Low-level X-ray radiation alone or after surgery to remove a keloid scar can help shrink the scar. More than one session of radiation therapy may be needed. Possible side effects of radiation therapy are damage to the skin and, in the long term, cancer.

Freezing the scar

Small keloids can be made smaller or removed by freezing them with liquid nitrogen. This treatment is called cryotherapy. It may be needed more than once. Sometimes cryotherapy is used before a keloid is injected with cortisone or another steroid. Possible side effects of cryotherapy are blistering, pain and a change in skin color. Skin color change typically is more noticeable on people who have Black or brown skin.

Surgery

When a keloid scar hasn't responded to other treatments, your healthcare professional might suggest removing it with surgery. Research shows that keloid scars treated with surgery alone have a high risk of coming back.

Lifestyle and home remedies

Try these keloid self-care tips:

• Follow your healthcare professional's directions. Wound care can take a lot of time. Compression dressings may be uncomfortable. But carefully follow the directions your healthcare professional gives you for wound care. Those steps are important to help prevent keloid scars.
• Use a corticosteroid cream or a silicone gel. These products can help ease the itchiness of a keloid scar. Silicone gel also might help flatten a keloid. You can buy these products without a prescription.
• Protect skin from the sun. Exposing a keloid scar to the sun could change its color and make it easier to see. That change may be permanent. Before going outside, protect your skin by covering the keloid scar or by putting sunscreen on it.