September 15, 2011

Keloids are a benign skin tumor characterized by excessive proliferation of scar tissue. They usually arise at sites of trauma or prior surgery, but occasionally arise spontaneously in areas prone to high skin tension. They develop as a result of increased activity of fibroblasts, the cell type responsible for the production of scar tissue collagen protein. The incidence is most common in African American patients.

A keloid appears as a protuberant, shiny, firm plaque, or nodule on the skin surface. Newer keloids still in the formative stages are often associated with pain or itching, and older lesions are generally asymptomatic. They may form on any part of the body, although the upper chest, shoulders, upper back, and earlobes (where piercing has occurred) are especially prone to keloid formation.

The diagnosis of a keloid can generally be made on clinical grounds, particularly in the setting of prior trauma. if the diagnosis is in doubt, biopsy should be performed to rule out a dermatofibrosarcoma protuberans, a malignant tumor that may look like a keloid.

Treatment of keloids is very difficult. Surgical removal of a keloid is fraught with potential for recurrence of an even larger lesion because more scar tissue may be stimulated to form. This approach may, however, be warranted if combined with another modality
to reduce likelihood of recurrence. Performing serial injections of corticosteroids with a small needle is a common approach for reducing symptoms and flattening the keloid. Silicone pads are of limited benefit in newer keloids. New approaches to keloid treatment that are still in the investigational stages include topical drugs that alter the inflammatory cell profile within the lesion, namely, cytokines. Evolving laser treatments may also be beneficial in reducing the size of keloids.

Without treatment, keloids continue to grow until they reach a steady state size, and regression without treatment is unusual. Tenderness and itching are the primary symptoms associated with a keloid, but the cosmetic disfigurement can be quite dramatic.

SEE ALSO: Piercing

Suggested Reading

  • Berman, G., & Bieley, H. (1996). Adjunct therapies to surgical management of keloids. Dermatological Surgery, 22, 126—130.
  • Tredget, E. E., Nedelec, B., Scott, P. G., et al. (1997). Hypertrophic scars, keloids, and contractures: The cellular and molecular basis for therapy. Surgical Clinics of North America, 77, 701—730.

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