Keloids

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Symptoms
Causes And Risk Factors
Prevention
Diagnosis
Treatment
Lifestyle/management
Prognosis And Complications
Alternative Treatments
References

Marks left behind from acne, cuts, or scrapes may leave permanent scars on the skin. When such scars grow excessively and are lumpy in texture, it leads to keloids or hypertrophic scars. These are thick and spread beyond the original boundary of the skin injury. They commonly develop on the chest, back, arms and the upper part of the hand. The exact cause of keloids is not yet clear, but they are believed to be the faulty formation of collagen when the skin is damaged during the healing process. Keloids can be healed with creams containing retinoids, steroids injection and surgery.

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Symptoms

Apart from the bumpy appearance, these irregularly shaped lesions are characterized by pain, tenderness and itching, but are not contagious. These symptoms usually subside once the keloid stops growing. These lesions can also develop after surgeries or even after minor skin injuries like insect bites.

Other symptoms of keloids that are characteristic of them are as follows.

They grow slowly and can take months before they turn up. They will continue to grow for years at a slow rate.

They are initially red, pink, or purple and later turn darker than the individual’s skin. The border of the keloid is usually darker than the centre of the keloid.

Keloids are different to touch- some are soft and doughy while others are rubbery and hard.

Keloids occur anywhere on the body - ears, neck, chest, shoulders, and back are the commonly affected areas.

The size of a keloid can vary from a few inches to more than 12 inches.[1]

Keloids are troublesome but not malignant (cancerous). This progressive disease can develop either suddenly after an injury or after a few months.

Causes And Risk Factors

Causes

The exact cause of keloids is still unknown. However, the scientific community believes that when an injury tears the skin, collagen – a protein in the body that provides strength and structure – forms quickly at the injured site as part of the healing process. Keloids occur when there is excessive growth of collagen in a scar. If there is debris in the wound, the collagen fibres will be laid erratically.

Common skin injuries that can cause keloids are as follows.

Puncture wounds

Cuts

Acne that is severe

Chickenpox

Post-surgical scars

Insect bites

Injection sites

Tattoos and piercings.[1]

Risk Factors

Certain hereditary factors can also be held responsible for causing this disease. The formation of keloid scars generally takes place on wounds or skin injuries caused by burns, surgical cuts, traumatic wounds, minor scratches, ear piercing, and acne. Individuals with darker skin tones and higher amounts of melanin are more susceptible to the formation of keloids. Other risk factors are as follows.

Being Asian

Your age is less than 30 years

Pregnancy

You are a teenager going through puberty

Family history of keloids,[1]

Prevention

In most cases, keloids are unavoidable. But there are a few steps you can take to minimize the possibility of their formation. It is well known that even something as simple as ear-piercing can produce keloids. Therefore, if you get a keloid after ear piercing, remove the earring and wear a pressure earring instead. Hence, if you know you have a tendency to develop hypertrophic scars, it is best to avoid as many cuts and surgeries as you can. Furthermore, always keep cuts and wounds clean. Studies have shown that wounds that become infected are more likely to form keloids. Therefore, if you do get injured, be sure to wash them thoroughly and wear a bandage.

Other preventive measures are as follows.

In case you are getting a tattoo, body piercing, or cosmetic surgery, you can try a test spot initially to see how your skin reacts to it. A pressure garment can help prevent thickened skin from developing into a keloid.

In case you are going in for surgery, inform your surgeon about your keloid-prone skin. He may take necessary precautions to avoid the keloid from forming. In case there is a thickening of the surgical scar, immediate treatment can help prevent keloid formation. Your dermatologist (skin doctor) can help you with a keloid treatment plan to suit your needs.[2]

Diagnosis

Keloids are usually diagnosed by observing them. If the keloid causes your dermatologist to be concerned due to any abnormality, he/she may perform a skin biopsy (removal of a small part of the skin to examine and study it). This skin biopsy can be done on an out-patient basis.[2]

Differential diagnosis

Keloids can be confused with hypertrophic scars as they can also occur with skin trauma. However, unlike keloids, hypertrophic scars grow only in the injured area and do not spread to the surrounding skin. Dermatofibroma is another type of scar formation. It results in a papule(raised area of skin) or nodule(abnormal growth of tissue). A “dimple sign” characterises a dermatofibroma which results in the centre getting depressed when applying pressure. Dermatofibrosarcoma protuberance is rare, it resembles keloids. They differ from keloids as they occur without trauma and have irregular borders. Xanthoma disseminatum, though rare, can be confused for keloids. Lobomycosis, which is a fungal infection, grows slowly like a keloid and mostly occurs in South and Central America due to exposure to rural soil or dolphins.[3]

Treatment

Medication: Medicated creams like those that contain retinoids can be applied topically to keloids to help them shrink. Another option is to use a topical solution called ‘scar silicone sheeting’, a frequently chosen topical keloid scar treatment, in which silicone is placed over the scar tissue in order to reduce the number of damaged cells. The benefit of silicone is that it not only protects the scar, but also helps it to retain moisture from healthy portions of the skin, thereby assisting in healing the damaged tissue. Injections: Steroid injections can be used to help shrink keloids and reduce swelling. A patient will need to get several shots over a few months to complete the treatment.

Ligature: Tying a thread around the keloid can cut into the keloid, causing it to fall off. You will need to replace the surgical thread every two to three weeks.

Radiation treatment: Radiation may be used to reduce the size of the keloid pre-surgery. Radiation therapy may also be used after surgically removing the keloid to prevent the recurrence of the keloid. This radiation therapy can begin immediately after the surgery or after a few days or weeks.

Cryotherapy: The skin beneath the keloid is saved while freezing the keloid from inside out to reduce the size and firmness of the keloid. This is called cryotherapy. It works best on smaller keloids. Cryotherapy treatments enhance the effects of the steroid injections, making them more effective in reducing the size of the keloid.

Laser treatment: laser treatment can help decrease the height and cause fading of the colour of the keloid. Laser treatment is used along with other treatments like pressure or corticosteroid injections for best results.[2] Surgery: Surgical intervention is often the last resort when it comes to treating keloids. Moreover, surgical removal of keloids may not be curative, since most keloids tend to recur. Better results have been seen with lasers or liquid nitrogen to burn or freeze the keloid scar. Mechanical Compression -- a natural treatment of Keloid Scars The most commonly used natural way to remove keloids is by applying pressure to the keloid through Mechanical Compression. Compression treatment helps control the growth of old keloid scars and prevents new scars from developing in individuals who are susceptible to them. Done by using mechanical compression dressings, this method has been used throughout history to treat keloids. Gentle pressure is applied to the keloid over a specified (often lengthy) period, typically 6 to 12 months. The keloid should be flattened and appear smoother after the successful removal of the compression device. It is not known how the compression of keloids reduces their appearance. However, it is speculated that the compression causes a restriction of blood flow and oxygen throughout the lesion, which reduces the production of collagen. The mechanical compression dressings are engineered to fit the patient, making it specific to the scar’s size and position and accommodating different pressures based on the keloid. This type of dressing is often made of a stretchy synthetic fabric (known as Spandex fabric), support bandages, and zinc oxide adhesive plaster. Compression dressings can also be used along with skin creams and injection therapy for faster results. The dressing will yield the most benefit if worn on a regular basis by the patient. This may sound like the best option when it comes to getting rid of keloids, but this method must be performed strictly under a doctor’s supervision.

Lifestyle/management

In case you have a wound and are prone to keloids, you need to take the following precautions.

Keep sterile petroleum gauze, wound dressing, silicone sheets or gel, and a water-resistant SPF 30 sunscreen.

Maintain cleanliness of the wound by washing it with soap and water to clean it without drying it.

Avoid using iodine, alcohol, or hydrogen peroxide as this will cause excessive drying of the wound.

Use sterile petrolatum gauze over the wound to keep it moist.

Clean your wound daily without rubbing it to avoid scar formation.

Keep the wound bandaged and covered to avoid exposure to UV (Ultraviolet) light as this can cause scarring and darkening of the scar.

Use of sunscreen can also avoid keloid formation, as they may take time to show up post wounds.

Use a sunscreen that is PPF 30, water-resistant, and has broad-spectrum protection for best results.

Silicone sheets or gel application on the wounds can help prevent the formation of scars or keloids.[2]

Prognosis And Complications

Prognosis

Keloidal scars are benign. They require treatment to relieve symptoms and for cosmetic purposes. As they have a genetic component, certain individuals may be at high risk of developing keloids after injuries or surgeries. They take time to regress. They have a high recurrence rate making it difficult to treat. For high-risk individuals, it is advisable to incorporate adjuvant therapy post-surgery to prevent a recurrence.[3,4]

Complications

Complications of keloids are as follows.

Prolonged pain

Pruritis (itching)

Cosmetic disfigurement

Functionally debilitating

Emotional distress

Psychological distress

Recurrence of keloids.[4]

Alternative Treatments

Natural Remedies

Numerous natural ingredients, like herbal extracts and essential oils, can be very effective in reducing the appearance of keloid scars and preventing their formation. Some studies have shown that onion extract, antioxidants like vitamin E, or cooling herbs, such as aloe vera, may help keloids to shrink and fade.

Topical Application of Herbal extracts and Natural Oils #1 A mixture of Mustard Seed Oil, Rose Essential Oil and Jojoba Oil can be applied to the skin to help get rid of keloid scars and other scars on the body. TIP: Mix 1 tablespoon mustard seed oil, 1 teaspoon rose essential oil and 8 tablespoons of jojoba oil in a small container and shake it vigorously to mix the ingredients. Gently apply a small amount of the mixture to the affected area and leave it on for 15 minutes before rinsing with cool water and washing with a mild cleanser. #2 Lavender Essential Oil, Calendula Essential Oil and Coconut Oil can also be applied to the keloid scars to reduce the problem. TIP: Mix ½ tsp. lavender essential oil, ½ tsp. calendula essential oil and 10 tsp. coconut oil. Shake vigorously to mix. Gently massage a small amount of the mixture to the keloid scar, leave it for 15 to 20 minutes before rinsing with cool, clean water and washing with a gentle cleanser. #3 A mixture of Vitamin E Oil, Aloe Vera Gel and Cocoa Butter can also reduce keloid scars. TIP: Mix 1 tsp. vitamin E oil, 2 tsp. aloe vera gel and 1 tbsp. cocoa butter in a small container, and stir to mix. Apply a thick layer of the mixture to the affected area and leave it on for 30 minutes. Wipe the excess off the skin and allow the rest to dry naturally. #4 Sandalwood and rose water form an excellent home remedy to get rid of scars. TIP: Mix sandalwood paste with rose water and apply it to the scar. Leave it on overnight and wash it off the next morning. #5 Using apple cider vinegar to treat keloids is one of the simplest home remedies. TIP: Dilute apple cider vinegar in water and apply this solution to the affected area to cure keloids. Follow this therapy for about 15-20 minutes several times a day. In case it causes skin irritation, dilute the solution further. #6 Applying calendula gel or cream to a scar twice a day reduces inflammation and increases healing in an early keloid scar. #7 Massage is also helpful for keloid scars. Although using oils like coconut or mustard oil is most beneficial. Massaging the stiff spots a few times a day will break down the tissue and soften the scars.