When I had a small skin tag removed from my chest about 20 years ago, I didn’t know I was prone to keloids, a type of raised scar. But I developed one right in the spot where the skin tag was, and looking back, I don’t know that I would have gotten the tag removed had I known that a keloid was a possible side effect.
The one-inch long keloid is smack dab in the middle of my décolletage and shaped a bit like a dog bone because it’s raised more on each side. Sometimes, people just stare at it. Other times, they ask me if I’ve had heart surgery (I have not), thinking it’s a post-surgical scar. One creative gal wondered if it was a unique kind of tattoo and encouraged me to make up a story to tell others.
If you, like me, are wondering about how keloids form and what you can do about them if you have one, here’s what you need to know.
What are keloid scars anyway?
Any scar is the body’s normal, healthy attempt to repair a skin injury. But a keloid is an overgrowth of scar tissue. Keloids can develop after any surgery (including C-sections) or trauma to the skin, including injuries, tattoos, and piercings. They also may occur after bouts with acne, says Katy Burris, M.D, a dermatologist with the department of dermatology at Columbia University Medical Center. Occasionally keloids form with no clear cause, according to the American Academy of Dermatology (AAD).
They tend to be thick, pink or brown, and can resemble a barbell, Dr. Burris tells SELF. Keloids grow slowly over several months and, unlike other types of raised (hypertrophic) scars, keloids grow beyond the bounds of where the original skin trauma occurred, Jason M. Preissig, M.D., a dermatologist with Mercy Medical Center in Baltimore, tells SELF.
Experts don’t fully understand why keloids form, but it seems like there is a genetic component: If you have a first-degree relative who gets keloids, you are also more likely to get them, the AAD says. And those with African American, Asian, or Hispanic ethnicities are also more likely to develop keloids.
Normally there are biological mechanisms in place to regulate the processes of repairing and regenerating tissue in healing skin. But when a keloid forms, that’s a sign that something is off in that balance. Lab research suggests that abnormalities in the production of melanocyte that stimulates hormone and collagen in the skin as well as the effects of stress on hormones, and prolonged inflammation at the injury site, could contribute to the formation of keloids. But we’re still far off from really understanding exactly why and how they’re produced.
Even people who are prone to keloids don’t always get them after a skin injury. The factors that determine whether or not you develop a keloid or a "normal" scar aren't totally understood, but we know that keloids are more likely to develop on certain parts of the body (like the ears, shoulders, chest, neck, and back) and under certain conditions (if the injury had a prolonged healing time, for instance).
The good news is that keloids aren’t necessarily something you need to be worried about. “They’re not an infection, they’re not contagious, and they’re not related to cleanliness,” Dr. Preissig says. “They just occur randomly.” Although keloids aren’t harmful, sometimes they do come with some pain or itching. (The only time mine hurt was after my son was born and I’d hold him toward my chest. Naturally, he’d want to touch the keloid area.)
However, it’s a good idea to see a dermatologist if you have a keloid, Dr. Burris says. For one thing it’s important to make sure it’s actually a keloid and not another type of raised skin issue. And if you do decide you want to treat your keloid, the earlier you start addressing it, the better chance that the treatment will work.
Treating keloids can be challenging, but there are several options.
Remember that keloids aren’t harmful or a sign of cancer. So there’s no medical reason to have them removed. But if you would like to pursue the idea because they cause discomfort or you simply don’t like the way they look, there are some options out there.
At first you might be tempted to try over-the-counter options including topical silicone sheets and gels. These usually need to be applied at least once a day and used continuously for months to see any results, SELF explained previously. These are also most effective when scars are new, and your dermatologist may advise you use this along with another treatment, such as a pressure dressing that reduces blood flow to the area to stop a keloid from forming.
But more often than not dermatologists will recommend going straight to corticosteroid injections into the keloid area, Dr. Preissig says. This won’t remove the keloid, but it can help thin it out by breaking up the bonds between collagen fibers and providing an anti-inflammatory effect. This is the most common treatment, Dr. Burris says, noting that the majority of people notice some difference. But it could take an injection once a month for four to six months to get the effects.
If your keloid is particularly thick or large, steroid injections alone may not be enough, Dr. Preissig says. In that case, your dermatologist may recommend using injections of 5-fluorouracil, a chemotherapy medicine used topically to treat actinic keratosis (a scaly, precancerous patch of skin) as well as some types of skin cancer. “Keloids aren’t cancer, but this type of injection has been very effective,” Dr. Preissig says. It can be used on its own or alongside steroid treatments.
It’s also possible to surgically shave down or completely excise a keloid so it’s less noticeable. But in many cases, again, the keloid comes back, Dr. Burris says. That’s why many dermatologists recommend combining treatments, like using compression, silicone sheets, injections, and surgery in the same patient.
Laser therapy is another option, which involves exposing the scar area to a high-energy beam of light that then kickstarts the healing and exfoliation process, resulting in improvements in skin texture and pigment. But laser treatments tend to be expensive and it may take several sessions to see results. Although lasers can usually lighten scars that have healed completely, it still helps to start treatment as early on in the process as possible.
Other options include radiation and cryotherapy treatment. Radiation, which includes X-ray therapy and internal radiation therapy (brachytherapy), in particular isn’t used as often because of the possible side effects, so doctors will carefully weigh the pros and cons of this approach before recommending it.
In cryotherapy, the keloid is exposed to extremely cold temperatures, which causes a process called cryonecrosis (literally injuring skin cells by freezing them.) This type of therapy has proven to be effective for reducing the size of keloids after several sessions, especially when combined with steroid injections, but it is also known to cause pain and a loss of pigment in the area.
No matter what type of treatment you choose, there’s a chance the keloid will grow back, according to the AAD. With surgery alone, it’s estimated that between 55 and 100 percent of keloids will recur. And estimates vary widely for other types and combinations of treatments, making it crucial that you talk to your doctor about the best options for your specific case.
If you’re prone to keloids, here are some things to keep in mind.
Proceed with caution before having any elective skin surgery, including breast augmentation, tattoos, or piercings because you are likely to develop keloids after those procedures.
That said, it’s not always a guarantee that you’ll have a keloid after surgery. For instance, I had a basal skin cancer removed from the tip of my nose in 2018, and my dermatologist was concerned about keloid formation (although they are much less common on the face). But I healed well and haven’t developed any keloids as a result of that surgery.
If you must have skin surgery, let the surgeon know if you are keloid-prone so they can potentially help lower your risk of forming more keloids. They may be able to inject corticosteroids into the area before surgery to prevent a keloid, for instance. And afterwards it’s crucial to follow any post-surgical instructions diligently. Often the use of petroleum jelly or silicone gels as recommended by your doctor can help keep the wound calm and healing without the formation of a keloid, Dr. Preissig says.
Ultimately keloids usually aren’t anything to be concerned about. But if they’re causing you any discomfort or you’d just prefer to have it removed for whatever reason, talk to a dermatologist.
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