Queloide Scar: What is it? Characteristics and Treatment

Definition What is it?

Keloid is a cellular hypertrophy (also known as a hypertrophic scar) that occurs in some regions of scarring lesions of the body, that is, it is “a scar that does not know when to stop growing”. It is characterized by a hardened scar, which rises above the normal level of the skin. The shape is irregular, and the lesion tends to increase progressively over time. Unlike normal scars, keloids do not decrease in thickness.

Usually, when the skin is injured by any agent, the healing process occurs leaving a flat scar. Sometimes this scar is thicker (or hypertrophic), but it does not extend beyond the margins of the lesion, which is called a “hypertrophic scar”.  Often, this type of scar improves with time, which reduces its thickness, and treatment can help to accelerate this process. It is different from the keloid scar, which may form over time after a skin injury and often goes beyond the margins of the original lesion (main distinguishing feature).

Most keloid scars appear after injuries or surgeries, but they can arise spontaneously or even in places of acne healing, burns or perforations in the body.

The keloid affects men and women equally. There is a higher incidence of keloid skin in young women than in young men, but this may be due to the more frequent habit among women who leave their ears lobules due to the use of earrings. It is observed that the incidence of keloids is fifteen times higher in people with darker skin, and it is believed that this risk is due to African descent and not because of the dark skin color.

In what part of the body can the keloid skin appear?

Keloid skin can develop anywhere in the body, but there are some regions where the incidence is higher. The thorax is the most affected region, both in the anterior (chest) and posterior (back), due to the increased thickness of the skin in these regions. On the other hand, this abnormal scarring also usually develops on the skin of the shoulder.

There are several cases of auricular keloid, specifically in the lobe of the ear. The person who puts an earring at times in the process of healing the hyperplasia settles. In some African tribes, according to the frequent incidence of keloids, the ears become points of high incidence. Interestingly, keloids rarely occur on the skin of the face. Most keloids usually appear within a year after the trauma.

What are the characteristics of keloid skin?

Keloid skins usually do not cause symptoms, but can sometimes be accompanied by itching or pain. The scars tend to be broad or thick, they are larger than expected, with a corresponding relationship between the shape and size of the initial lesion.

The scar begins as a well-defined pink or a reddish plate, firm and elastic consistency. Excessive and uncontrolled growth causes the scar to grow beyond the limits of the original lesion, becomes smooth, irregular, hyperpigmented, and rigidly symptomatic.

Treatment for this type of scar

First of all, it should be emphasized that there is no cure for keloid skin, that is, there is no way to totally eliminate the problem. Currently, studies are being conducted with the objective of identifying an agent that can provide a more effective treatment, which may be able to help prevent its occurrence.

The available treatments have variable results and, in addition, any interference in a keloid skin can lead to an increase in size or other keloid formation. The treatment options are the following:

Bandage: is a type of safe and painless treatment, consisting of the application of coatings (such as a bandage) made of silicone or a substance called “Silastic”. These dressings seem to reduce the thickness of the keloid scar over time.

Compressive bandages: when used for prolonged periods, sometimes for up to 12 months can lead to reduction of the size of the keloid scar. This strategy is also effective in preventing further scarring.

Surgery: the procedure must be delicate, since it requires great care on the part of the surgeon. Although there was a recurrence rate of 45%, this value can be significantly reduced when the combination of other treatments is used. The removal of scars by means of laser surgery can also be followed by the injection of corticosteroids.

Corticosteroid injections: they are better indicated at the beginning of scar formation, or when it is known that the person already has a predisposition to the formation of keloid skin. In such cases, the results are better. These injections are administered inside the scar, which helps to reduce the size of the keloid scar and the irritation caused by it. The biggest drawback is that the injections cause a lot of discomfort, and the use of local anesthesia (adolescents and adults) or minors (children) may be necessary. The person may also feel pain for some time after the application.

Cryosurgery: optimal treatment for small keloid scars and people with lighter skin tone. Typically, this treatment is used in combination with corticosteroid injections. In this type of therapy, nitrogen is used at a very low temperature, below which it manages to alter the circulation and leads to the death of excess keloid tissue. There is new skin formation and the tissue may be lighter.

Radiotherapy: it is not used in a way that penetrates the body, it will only have an effect on the skin. It is used after surgery, and is the most expensive treatment.

Laser therapy: the laser promotes the skin fall (or desquamation) of the surface, but does not change the thickness of the keloid.

Natural Treatments: indicated when the keloid piercing occurs after implantation. You can request on the spot a cloth dampened with hot water, or even a tea bag submerged in hot water too. It should be applied for five minutes, this helps to improve the aspects of the scar.