A keloid is a type of dense, raised scar tissue that forms at the site of a skin injury, which is a common concern for people with piercings. This tissue overgrowth occurs when the body produces an excessive amount of collagen during the natural healing process. While the sight of a raised bump near a piercing can be alarming, many people often mistake a less severe, temporary type of scarring for a true keloid. Understanding the precise nature of the growth is the first step toward deciding on the appropriate course of action.
Keloid Versus Hypertrophic Scar
The distinction between a true keloid and a hypertrophic scar is important because it dictates the necessary treatment and outcome. Hypertrophic scars are the most common type of piercing bump, presenting as a raised, pink, or reddish lump that remains confined to the original piercing wound site. They develop within a few weeks of the piercing and are often a result of localized irritation, such as jewelry movement, poor quality material, or improper aftercare. These bumps respond well to simple irritant removal and improved cleaning routines, often reducing in size and flattening over time.
A true keloid is a more aggressive reaction to skin trauma that extends beyond the boundaries of the original injury. These growths can appear months after the initial piercing and continue to enlarge, becoming firm, smooth, and sometimes itchy or tender. Keloid formation is linked to genetic predisposition, meaning individuals with a family history of keloids are more likely to develop them. Unlike hypertrophic scars, keloids do not regress on their own and require professional medical intervention for reduction or removal.
Guidance on Jewelry Removal
The question of whether to remove the jewelry depends entirely on the nature and stage of the scar tissue. If the bump is small, newly formed, and localized—suggesting a hypertrophic scar—it is advisable not to remove the jewelry immediately. Removing the jewelry prematurely can cause the piercing canal to close, potentially trapping bacteria and irritation-causing debris inside. This can worsen inflammation or complicate future treatment. Instead, focus on eliminating the source of irritation, such as switching to a high-quality, inert metal like titanium and strictly adhering to gentle aftercare.
If the growth is clearly a large, established keloid that is rapidly expanding or has been medically confirmed, the decision changes. The jewelry may need to be removed to facilitate necessary medical treatments, but this should only be done under the direct guidance of a dermatologist or physician. A medical professional can assess the growth and determine if removal is necessary before beginning specialized treatments, like steroid injections. Consulting a piercer first can also be helpful, as they may suggest changing the jewelry type or size to relieve pressure before resorting to full removal.
Clinical Treatment Options
Established keloids require interventions performed by medical specialists, such as dermatologists or plastic surgeons, as they will not disappear with standard piercing aftercare. One common and effective treatment involves intralesional corticosteroid injections, where medication is directly injected into the keloid to reduce inflammation and shrink the tissue. These injections are often administered in a series every few weeks and are successful in shrinking a significant percentage of keloids.
Other non-surgical methods include cryotherapy, which freezes the keloid tissue using liquid nitrogen to destroy the excess cells and reduce its size. Laser treatments, such as pulsed dye lasers, can also be utilized to flatten the scar and reduce its discoloration, often used in combination with other therapies. If a keloid is large, surgical excision may be performed. However, this is typically combined with a secondary treatment like post-operative radiation or pressure earrings because surgery alone carries a high risk of the keloid returning even larger than before.
Reducing Future Risk
Individuals with a known predisposition to keloids or those who have had one previously should take preventative measures for any future piercings. The choice of piercer is important; selecting a professional who uses sterile techniques and single-use needles minimizes trauma and infection risk. The material of the initial jewelry is also a factor, with non-irritating options like implant-grade titanium or high-quality gold being the preferred choice to reduce the potential for an adverse reaction.
Meticulous aftercare is necessary, focusing on cleaning the piercing twice daily with a sterile saline solution and avoiding harsh chemicals like alcohol or hydrogen peroxide. Trauma to the healing site must be avoided, meaning you should never touch the jewelry, sleep directly on the piercing, or allow clothing to snag it. Recognizing any family history of keloids or the appearance of thickening skin around a new piercing should prompt a quick consultation with a dermatologist to begin preventative measures, such as silicone gel application, before the keloid fully forms.