Keloids

A keloid is a pathological type of raised scar that extends beyond the boundaries of the original wound and continues to grow over time. Unlike hypertrophic scars — which remain within wound margins and often flatten spontaneously — keloids invade surrounding healthy skin, may become quite large, and rarely resolve without treatment. Keloids can follow any skin injury: surgical incisions, piercings, acne, burns, chickenpox, and even minor scratches. They are most common on the earlobes, upper chest, shoulders, and upper back. Keloids are benign but can cause significant physical discomfort (itching, pain, tenderness) and psychological distress.

• Raised, firm, rubbery scar extending beyond the original wound margin
• Skin may be pink, red, purple, or darker than surrounding skin
• Itching — often persistent and intense
• Pain or tenderness, especially when touched or when clothing rubs
• Continued growth over months to years after initial wound healing
• Restricted movement if over a joint

There is no screening test for keloids. Prevention is the most effective strategy for susceptible individuals: avoid elective piercings (especially through cartilage), minimize skin trauma, keep wounds moist during healing, apply pressure dressings or silicone sheets immediately after wound closure, and inform all healthcare providers of keloid history before any surgical procedure so preventive protocols can be implemented.

Per AAD guidance, intralesional corticosteroid injections (triamcinolone acetonide) every 4–6 weeks are the first-line treatment for most keloids — flattening the scar and reducing itch in 50–80 percent of patients. Silicone gel sheets and silicone dressings have good evidence for flattening established keloids and preventing recurrence after treatment. Cryotherapy (freezing), pulsed-dye laser, and CO₂ fractional laser target vascularity and collagen. Surgical excision alone has a keloid recurrence rate exceeding 50–80 percent and should always be combined with adjuvant therapy — typically post-operative radiation (low-dose superficial radiotherapy within 24 hours of excision) or intralesional steroid injections beginning immediately post-operatively. 5-fluorouracil intralesional injection is an emerging evidence-supported option for refractory cases. Imiquimod cream applied post-excision reduces recurrence.