Squamous Cell Carcinoma

What is a keloid?

Keloids are scars that grow over time and extend beyond the initial site of injury due to impaired wound healing. They frequently recur and rarely regress. Keloids are aesthetically disfiguring, cause pain, itching and discomfort, psychological stress, and affect quality of life.

Formation of scar tissue is a normal part of healing, but some individuals are prone to develop keloid scars and hypertrophic scars.

A keloid can develop anywhere the skin is injured including the joints and the mouth, but typically develops on the earlobes, cheeks, chest, shoulders and upper back.  Keloids are not harmful but can cause discomfort and impair quality of life due to cosmetic concerns.

What is the difference between a keloid scar and a hypertrophic scar?

Hypertrophic scars are the result of abnormal wound healing usually in areas with high skin tension like the shoulders, neck, knees and ankles but are confined to the area of injury and tend to regress spontaneously over time. Keloid formation is an abnormal form of wound healing that results in excessive production of collagen. The scar extends beyond the area of injury, invades nearby tissue and does not regress over time.

What are the symptoms of a keloid scar?

A keloid is a raised, red, thick, lumpy, hard, rubbery, shiny scar. A keloid tends to begin as red or purple scar that matures over weeks or months into a skin-colored lumpy scar. It may not form immediately after an injury but develops months to years later. In a younger person, a keloid can enlarge as the person grows.

What causes a keloid?

The exact cause is unknown but is believed to be an inherited abnormal response to tissue injury, linked to inflammation. When the skin is injured, the body heals it with deposits of collagen to fill in the open wound. A keloid scar occurs when there is an overproduction of collagen.

A keloid can develop from an insect bite or a pimple, a burn, an injection, vaccination, chicken pox, and surgery in genetically susceptible individuals. The type of injury doesn’t determine whether a keloid will develop, but if you have known risk factors it is wise to avoid tattoos, piercings and unnecessary surgeries.

What are the risk factors for developing a keloid scar?

About 10% of people aged 10 – 20 develop keloid scarring.  Keloids tend run in families and affect young women more than men. Known risk factors include:

• an inherited abnormal response to tissue injury
• dark skinned individuals of African, Asian and Hispanic descent
• being younger than age 30
• Having blood type A
• hormones during puberty and pregnancy.

How is a keloid diagnosed?

Because of its appearance a keloid can be diagnosed by looking at the affected area. However, when Dr. Higgins is concerned that the growth may be skin cancer, she may take a small biopsy of the scar and send it to a lab for diagnosis.

What are the treatments for a keloid scar?

Keloids and hypertrophic scars are characterized by continuous local inflammation and excessive collagen deposits. Thus, treatment is often targeted to reducing inflammation to suppress scar formation. Treating keloids can be complicated and difficult and requires a combination of treatments to achieve the best results.  The following list is only a partial list of all the tools available to Dr. Higgins to improve keloids.

Current agents include:

• Steroids are well known for their anti-inflammatory effect and are effective to treat keloids and hypertrophic scars. Injection into keloids has proven success in scar treatment.
• Silicone gel dressings are pressure therapy and are considered a first line treatment for scar management to reduce symptoms and inflammation. They are used to stabilize the wound and prevent keloid formation. Studies report improvement of up to 90% in keloids.
• Onion Extract ointment is anti-inflammatory and effective in scar management.
• Chemotherapy drugs injected into the keloid
• Botox has anti-inflammatory effects on wound healing and scar formation.
• Laser therapy can improve the appearance of the scar.
• Surgical excision is not recommended unless combined with other forms of therapy
• Radiotherapy is effective to prevent and treat keloids as an adjunct to surgical excision.
• Cryotherapy is used to alone or in combination with other therapies.
• Light therapy

A combination of treatments is often required to improve the scar, but recurrence rates are high.

If you are genetically predisposed to developing keloids, it is important to get early treatment for conditions that cause scarring such as acne. Prevention is the best treatment.

Dr. Heather Higgins is a board-certified dermatologist in Asheville North Carolina. Contact her to schedule a consultation and learn about all your treatment options.