Keloid skin lesions are a distinct type of raised scar tissue that develops following skin injury. Unlike typical scars, keloids are benign growths. They form as a result of an abnormal healing process, where the body produces an excessive amount of scar tissue.
Understanding Keloids
Keloids are characterized by their firm, rubbery, or shiny texture, often appearing as raised nodules or lumpy ridges. Their color can vary, ranging from pink or red to dark brown, and they may be darker than the surrounding skin. These scars are unique because they grow beyond the original boundaries of the wound, expanding into healthy skin. They can also cause symptoms like itching, pain, or tenderness, and may feel irritated by friction from clothing.
Keloids form when the body’s natural wound healing process goes into overdrive, leading to an overproduction of collagen. This excessive fibrous tissue deposition results in their raised appearance. While any skin injury can potentially lead to a keloid, common causes include surgical incisions, acne scars, piercings, tattoos, burns, minor scratches, and vaccination sites. Keloids are most common in individuals younger than 30, with a higher incidence in people of African, Asian, and Hispanic descent, and often have a genetic predisposition. Common anatomical sites include the earlobes, shoulders, upper back, and mid-chest, areas often subject to skin tension.
Distinguishing Keloids from Other Scars
Differentiating keloids from other scar types, particularly hypertrophic scars, is important due to their distinct characteristics and treatment approaches. Both are raised scars resulting from excess collagen production, but their growth patterns differ significantly. Hypertrophic scars remain confined within the original boundaries of the wound or injury, and may even flatten over time.
In contrast, keloids actively extend beyond the original wound margins, invading the surrounding healthy skin. Hypertrophic scars typically develop soon after an injury and may improve or resolve within a year, while keloids can continue to grow and thicken for months or even years, rarely regressing spontaneously. Keloids are also often firmer, more rubbery, and can have a darker pigmentation compared to hypertrophic scars, which tend to be pink or red.
Treatment Approaches for Keloids
Treating keloids often involves a combination of medical and procedural approaches, as monotherapy may not completely flatten them. Corticosteroid injections are a common first-line treatment, particularly for smaller keloids, aiming to reduce thickness by diminishing collagen synthesis. These injections are typically administered monthly for up to six months. Silicone sheets and gels are widely used, often considered a standard treatment, and work by hydrating the scar and creating an occlusive environment to influence fibroblast regulation and decrease collagen synthesis. Silicone products can reduce pain, tenderness, and itching, and may flatten keloids.
Other treatment options include:
- Cryotherapy, which involves freezing the keloid with liquid nitrogen, can reduce or remove smaller lesions by causing cellular damage. This method may require repeat treatments and can lead to temporary side effects like blistering or changes in skin color.
- Laser therapy, such as pulsed-dye lasers, can flatten larger keloids, ease itchiness, and help them fade, often delivered over several sessions.
- Surgical excision can remove keloids, but it carries a high recurrence rate (45-100%) if not combined with other therapies like radiation, corticosteroid injections, or pressure therapy.
- Pressure therapy, using compression dressings or garments, applies consistent pressure to the healing wound to reduce or prevent scar formation by limiting collagen buildup. This may need to be worn for 12 to 24 hours a day for 4 to 6 months.
Preventing Keloid Formation
Minimizing the risk of keloid formation, especially for individuals with a predisposition, involves proactive wound care and strategic interventions. Proper and timely care for any skin injury, including cleaning and disinfection, helps mitigate the impact of trauma. Avoiding unnecessary skin trauma, such as elective piercings or tattoos, is advisable for those prone to keloids.
For individuals at higher risk, early intervention with treatments like silicone sheets or pressure garments on new wounds is recommended. Silicone gel sheets, applied to newly healed wounds, can help flatten and soften scar tissue, potentially preventing keloid development by maintaining a hydrated environment. Pressure garments or dressings apply consistent pressure to the healing area, preventing excessive collagen buildup and minimizing scar prominence.