Keloid scars form within months to years after an injury. They can form even after a harmless injury like acne, a bug bite, or an intentional piercing. Keloids can occur anywhere on the body but are most common on the trunk, arms, chest, and head. If they are present on a joint, they can inhibit movement. Luckily, keloid scars are not contagious.
What Are Keloid Scars?
Keloids are thick and irregular-looking scars. They usually have a shiny, raised appearance and can cause minor discomfort. They range from flesh color to red or purple and can develop a variety of textures. Keloid scars are usually harmless, but some people find them distressing. In rare cases, they can be itchy, painful, or uncomfortable. Once keloids start to form, they can continue to grow for years, causing the scar to increase in size. Some keloids can grow as large as a grapefruit!
What Causes Keloid Scars?
Collagen helps repair skin injuries. This protein helps scars form normally. However, sometimes during the healing process, your body produces too much collagen, resulting in a keloid scar. Doctors are not sure why some people's bodies produce too much collagen after an injury.
Keloid scars are more common in people with darker complexions, and some experts believe there may be a genetic component in why some people tend to get them more than others. If you've ever had a keloid scar, you are more likely to get another one after a future injury. Additionally, people between the ages of 20 and 30 are the most likely to develop keloids.
Keloid Scars Treatment Options
Many treatments for keloid scars focus on reducing the collagen in the area. So, what kills collagen in keloid scars?
Topical silicone gels and sheets. Topical silicone treatments to prevent keloids or stop them from growing are available over the counter. Experts theorize that silicone bonds with skin molecules and creates higher surface tension, encouraging the body to reduce collagen production in the area. These products may also help to repair broken blood vessels, reducing redness in scars.
Dermatologists recommend using silicone-based products for scars for at least 12 hours per day. Silicone gels and sheets work best on small keloids or as a preventative measure on fresh scars.
Steroids. An injection of a corticosteroid can reduce the size of a keloid scar. In general, steroids reduce inflammation and redness. However, they are helpful for keloids because they break up the connections between collagen molecules.
You can receive a steroid injection on an already existing scar. If you are getting surgery and are prone to keloid scars, your doctor may give you a steroid injection before or during the surgery as a preventative treatment.
To treat a previously existing keloid scar with steroid injections, experts recommend a series of five shots given four to six weeks apart to reduce the size and improve the appearance.
Low-dose radiation. Some keloid scars can be treated with a low-dose radiation therapy known as superficial external beam therapy. This beam uses highly directed x-rays on the scar. It only penetrates the topmost layers of skin. It destroys the cells in your skin that produce collagen and causes fewer new scars to form. This treatment causes no pain and only takes about ten minutes. Superficial external beam therapy is only recommended if over-the-counter gels or steroid injections do not work.
If you have a keloid scar removed surgically, your doctor may also recommend this treatment to prevent the scar from growing back.
Cryotherapy. Smaller keloids can sometimes be frozen off using liquid nitrogen. This treatment can cause side effects, including blisters, pain, and a change in the color of the affected skin.
Surgery. If nothing else works, your doctor may recommend surgery to remove your keloid scar. However, up to 100% of keloid scars come back after surgery. Your doctor will likely recommend another treatment to go along with the surgery, such as steroid injections, to reduce the risk of further scarring.
Following your doctor's instructions after surgery will reduce the risk of the scar returning. Your doctor may tell you to wear a pressure garment for up to 20 hours per day for at least a few months to reduce the risk of a new scar forming.
Keloid Scars Versus Hypertrophic Scars
Keloid and hypertrophic scars are somewhat similar. They are both caused by extra collagen production during the healing process. However, a hypertrophic scar stays within the bounds of the original wound. A keloid scar can grow beyond the original injury. Other differences include:
- Hypertrophic scars develop a couple of months after an injury, while keloids can develop months or years after.
- Hypertrophic scars are easier to treat.
- Hypertrophic scars are pink to red; keloids are red to purple.
- Hypertrophic scars can go away independently, while keloids will never go away without treatment.
How to Prevent Keloid Scars
The only surefire way to prevent a keloid scar from developing is to avoid injuries. That is not always possible — accidents happen. However, if you know you are prone to getting keloids, you may want to avoid intentional injuries such as piercings, tattoos, or injections.
If you do get an injury, take care of it properly:
- Keep your wound clean by washing it regularly with soap and water
- Cover the wound with Vaseline or Aquaphor to keep it moist
- Use a silicone gel pad or pressure pad to reduce the risk of developing a keloid scar
- Follow your doctor's instructions for wound care after any surgery or procedure
- Use these methods for six months after an injury if you're an adult
- Use these methods for 18 months after an injury if you're a child
Keloid Scar Outlook
Keloid scars are annoying and sometimes distressing to those who get them, but they are typically harmless. Work with your dermatologist to find the treatment option that works best for you to reduce the size of your keloid scar or get rid of it entirely. Early treatment can minimize a keloid's growth, so it's essential to talk to your doctor once you notice that one is forming.