Definition

Keloids are overgrowths of fibrous tissue or scars that can occur after an injury to the skin. These heavy scars are also called cheloid or hypertrophic scars. In individuals prone to keloids, even minor traumas to the skin, such as ear piercing, can cause keloids.

  Description

Keloids can occur anywhere on the body, but they are most common on the earlobes, upper back, shoulders, and chest. They consist of hard, raised scars that may be slightly pink or whitish. These may itch and be painful, and some keloids can grow to be quite large.

  Causes and symptoms

Although the cause of keloids is unknown, it is thought that they are due to the body's failure to turn off the healing process needed to repair skin. When this occurs, extra collagen forms at the site of the scar, and keeps forming because it is not shut off. This results in keloid formation.

Keloids occur most frequently in individuals of African-American descent and in those with darker skin. Other risk factors include a family history of keloids, surgery, acne, burns, ear piercing, vaccinations, or even insect bites. In addition, women and young people under the age of 30 are more prone to develop them.

Initially, keloids will begin as a small lump where the skin has been injured. This lump grows and can eventually become very large and cosmetically unacceptable.

  Diagnosis

A dermatologist can usually make the diagnosis of a keloid based on looking at the scar. In some cases, however, a biopsy may be necessary to rule out other types of skin lesions, such as tumors.

  Treatment

The treatment of choice for keloids is usually an injection of corticosteroid drugs such as cortisone directly into the lesion. These injections cause the keloid to become atrophic, or thinner, and are repeated every three to four weeks until the keloid has been resolved to the individual's satisfaction. Other therapies, include laser treatment or radiation therapy, and topical treatments are undergoing study.

Surgery is often used in combination with corticosteroid injections. The injections are given for several weeks, and then the keloid is surgically removed. The injections are then continued for several weeks. Surgical removal of the keloid may also be used in conjunction with radiation therapy, which delivers small amounts of radiation to the affected area.

Newer approaches include silastic gel sheeting, which makes use of pressure to flatten the keloid. The gel is applied and kept securely in place with tape, cloth, or an ace bandage. The dressing is to be changed every seven to 10 days, for as long as 12 months.

Finally, researchers are now studying a type of tape that has been soaked with steroids, which are released slowly into the keloid, causing it to thin over time.

  Prognosis

Although keloids are unsightly, they are not life threatening. Keloids do not have a tendency to develop into malignancies, but they can become cosmetically unacceptable. Keloids can gradually lessen after treatment, but many recur. And just as they can occur spontaneously, they can also resolve spontaneously.

  Prevention

Preventive measure include avoiding any trauma to the skin, and compression pressure dressing for high-risk patients who have suffered burns to their skin. Patients with a tendency to form keloids should avoid any sort of elective surgery. Individuals who are prone to develop keloids or who have a history of keloids should immediately care for any cuts or abrasions they may sustain.

   Key Terms:

Atrophy A wasting away of, becoming thinner, less strong. Corticosteroids Any of several steroid medications used to suppress inflammation, allergic, or immune responses of the body.

   Resources:

Organizations

• American Academy of Dermatology. 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. Fax: (847) 330-0050 http://www.aad.org.

Other

• "Keloids." Black Women's Health. http://www.blackwomenshealth.com/Keloids.htm.
• http://www.skinsite.com.