What are Keloids?
Keloids, also referred to as Keloidal scars, are an extreme overgrowth of collagen fibers at the site of a healed skin injury. Keloids are harmless, benign (non-cancerous) skin lesions resulting from an overgrowth of granulation tissue during the healing process.
They sometimes cause itching and pain and can limit skin movement in some people. Keloids are a serious form of scarring as they can continue to grow indefinitely into large growths beyond the borders of the original wound. Keloidosis is a term used when multiple or repeated instances of keloids are formed on the skin.
Keloid Scars can result from any of the following skin injuries:
- Minor scratches
- Surgical incisions
- Traumatic wounds
- Vaccination sites
Symptoms of Keloids include the following:
- Raised mound of scar tissue at the site of an healed skin injury
- Pigmentation of the skin
Keloid scars have two main predisposing risk factors:
- Location of the scar
- Genetic background of the patient
Keloids are more common in the upper part of the body and are rare in the eyelids, soles of the feet, palms of the hand and genitals. Keloids are most likely to develop in the following locations:
- earlobe after ear piercing
- border of the jaw
- chest/breast in women
- Keloids are uncommon in people with fair skin. These patients are more likely to develop hypertrophic or thick scars which eventually fade. The difference between these two types of scar is often hard to determine.
- Keloids are more common in patients with dark skin.
- Women are more likely to develop Keloidal scars.
- Young people under the age of thirty are at highest risk.
Other Risk Factors
- Keloids are more likely to form when the wound is closed under tension or where there is an infection or hematoma (bleeding) after surgery.
- If a foreign body is present in the wound, as may occur after an accident, keloids also seem to be more likely to develop.
- In cosmetic surgery some scars are more likely to become thicker, these include the scars associated with: otoplasty (ear pinning), breast reduction and abdominoplasty (tummy tuck).
Scar tissue may be minimized to a degree by proper attention to the injury and proper care during the healing process. Preventing complications such as infection and treating medical conditions that affect healing such as diabetes can help minimize scarring. Minimizing swelling and increasing the blood supply to the injured area also help in the healing process and minimize scarring.
Other measures to minimize scarring may include the following:
- Occlusive Dressings
Occlusive dressings include silicone gel sheets and dressings, non-silicone occlusive sheets, Cordran tape, and Scarguard. These measures have been used with varied success. Anti-keloidal effects appear to result from a combination of occlusion and hydration, rather than from an effect of the silicone.
- Compression Therapy
Compression therapy involves pressure, which has long been known to have thinning effects on skin. Reduction in the cohesiveness of collagen fibers in pressure-treated hypertrophic scars has been demonstrated by electron microscopy. Compression treatments include button compression, pressure earrings, ACE bandages, elastic adhesive bandages, compression wraps, Lycra bandages, and support bandages. Other pressure devices include pressure-gradient garments made of lightweight porous Dacron, spandex (also known as elastane), or bobbinet fabric (usually worn 12-24 hours/day for up to 4-6 months) and zinc oxide adhesive plaster.
No single therapeutic modality is best for all keloids. The type of therapy used is determined by:
- Location, size, and depth of the lesion;
- Age of the patient;
- Previous response to treatment.