Keloid

Keloids or keloid scars may present as:

• A thick, usually rounded, irregular cluster of scar tissue
• The scars are firm, raised and hard
• The scars may grow larger over time
• The scars may appear from slightly pink to very dark
• Keloids may turn darker than the rest of the skin on exposure to the sun
• Keloids can get itchy and painful if they rub against your clothes

Keloids form where the skin has been damaged by a surgery cut, piercing, acne, burn, chickenpox scar or vaccination site. Though rare, the original scar may also form due to scratches.

Keloids form when thick tissue grows from an area that is healing after an injury. This thick tissue results in a bigger scar than would have been formed otherwise. It is believed that keloids can be passed on to future generations. They are typically seen in people with darker skin.

Keloids cannot be prevented entirely. But if you are prone to keloids, you take the following precautions to prevent keloid growth:

• Avoid cutting or piercing your skin deliberately. Try to avoid tattoos, piercings or unnecessary surgeries. Use pressure earrings after ear piercings
• If you have a history of keloids, do the following after a minor skin injury:
  • If you get hurt, cover the wound with a thin layer of petroleum jelly and wrap it with a non-stick bandage. Drape the bandage tightly around the wound to apply even pressure on it. You may wash the area with soap and water every day to prevent contamination
  • Apply a silicone gel bandage once the wound has healed, to keep the pressure intact. You must keep the bandage on for 12-24 hours a day for two to three months as keloids usually grow within three months of healing. Research shows that 34% of raised scars can flatten after the use of silicone gel bandage daily for six months

The diagnosis of keloids is done on the basis of its appearance and the history of injury. The doctor takes a complete medical history of the patient and asks about any recent surgery, acne or body piercings. In the case of recurrent keloids, the doctor may perform a biopsy by removing a small piece of the skin to examine the underlying cause.

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The treatment of keloids can vary from case to case, based on the keloid's size and location. Treatment is done with the aim to reduce keloids and prevent their recurrence. Some of the common treatments are:

• Cryotherapy: Cryotherapy is a treatment in which the keloids are frozen from the inside out, to save the skin under the keloid. This therapy helps in reducing the size and hardness of a keloid. Cryotherapy is usually used for small-sized keloids.
• Injections: Doctors may use corticosteroid injections to reduce the size of the keloid. Corticosteroids works better when used along with cryotherapy or after surgical removal of the keloid. The doctor may also use other injectable medications such as fluorouracil, triamcinolone, verapamil, bleomycin or interferon alfa-2b shots, to shrink the scar. These medications are mostly used when the corticosteroids are unable to bring any improvement in the keloid. These injections are usually given to the patients once every three to four weeks. The effects of the injections are seen in the first appointment itself as they make the keloid softer and around 50% to 80% of the keloids shrink after getting these injections. 
• Surgery: Larger keloids can be removed with the help of surgery. However, surgical removal may result in the formation of more keloids. In order to avoid that, the person would have to take further precautionary measures like:
  • Covering the area with a silicone gel bandage after surgery, for 12-24 hours a day for two to three months, depending on the site and size of the removed keloid
  • Keeping the surgical site under constant pressure with the help of a wrap or a bandage
  • Some dermatologists may also recommend corticosteroid injections, radiation treatment or cryotherapy after the surgery to reduce the risk of keloid recurrence
  • For some time after surgical removal of a keloid on the earlobe, the person must wear a special earring that puts pressure on the earlobe
• Laser treatment: Some dermatologists may also use Nd:YAG lasers to reduce the length and neutralise the colour of a dark keloid. Laser therapy can also be used along with corticosteroid injections or the application of pressure.
• Radiation treatments: Radiation therapy helps in reducing the size of the keloid and also prevents its regrowth. Radiation therapy is usually used after surgical removal of the keloid.
• Ligature: In some cases, the doctor may tie a surgical thread around the keloid and eventually the thread would cut into the keloid, making it fall off. The thread has to be changed once every two to three weeks.