What is a keloid?

A keloid is a greatly enlarged scar that projects above the skin surface.  Skin heals by formation of scar tissue, which at first is often red and somewhat prominent.  As the months pass, a scar usually becomes flat and white.  Unfortunately, sometimes scars enlarge to form firm, smooth, hard growths called keloids.

What causes keloids? 

No one knows why keloids form.  While most persons never form keloids, others develop them after minor injuries and even after insect bites or pimples.  Keloids may form on any part of the body, although the upper chest, upper arm, and back are especially prone to keloid formation.  Dark-skinned persons form keloids more easily than Caucasians.

General information about treatment

There is no completely satisfactory treatment for keloids.  Even after an apparent cure, they sometimes return.  If this happens, it will usually occur within one to two years.  Treatment is easiest for keloids of the earlobe and is most difficult for keloids of the chest and shoulders.   Treatment is even more difficult in patients with multiple keloids and in patients with keloids that have returned after prior therapy.

What different treatments are there?

Injection of cortisone medications:

This technique often causes marked improvement, particularly in relatively small keloids.  Complete cure, however, does not usually occur.  The medication is injected with a needle directly into the keloid. It will need to be repeated several times usually at one month intervals.

Side effects of cortisone treatment:  It is not uncommon for the surrounding skin to become lighter in color than normal and to develop a slight depression (loss of thickness).  This will usually resolve within one year.

The amount of cortisone used will not cause health problems.  However, if you have diabetes, a history of stomach or duodenal ulcer, tuberculosis, or high blood pressure, be sure to let your dermatologist know.

Surgical removal: 

This technique is often required especially if injection of cortisone is not feasible or is unsuccessful.  It is the usual treatment of very large keloids on the trunk and most keloids on the face.  The disadvantage of surgical removal is that the keloid may occasionally re-grow to an even bigger size than it was before the surgery.  Sometimes, surgical removal is combined with cortisone injections before or after surgery. Silicone gel dressings applied after surgery can decrease the risk of recurrent keloid formation.

Other treatments: 

If the keloid is itchy or red, VBeam laser treatment can be used.  This treatment does not remove the keloid but rather dries up the blood vessels inside the scar.  The keloid may remain raised but lose its coloration and itchy symptoms.

Excision of keloids using a laser is possible, but the results are no better than other techniques and may even be worse.  In unusual cases, radiation (x-ray) treatment may be tried.

Topical creams containing the onion extract, Allium cepa, have some success in reducing small keloids.