Keloids are dense, thick nodules, typically found at areas of previously injured skin (burns, lacerations), or they may arise spontaneously on normal skin. They may be single or multiple. Over weeks to months, these nodules can become painful, tender, itchy (pruritic), and grow to become very large, up to about 30 cm. They can be unsightly, and patients often seek removal.
Who's At Risk
Keloids affect people of all ages, but most patients start developing keloids in their 20s. Keloids are most frequent in blacks and individuals of Mediterranean ancestry, but they can appear in people of any race.
Signs and Symptoms
Keloids are usually seen on the neck, ear lobes, legs or arms, and on the upper trunk, especially the chest. They frequently follow the lines of injury. Spontaneous keloids are common on the mid-chest. Keloids are smooth and shiny, firm to the touch, red, hyperpigmented or skin-colored nodules with regular or irregular ridges. Keloids may develop projections that extend beyond the area of injury.
None necessary except to avoid unnecessary skin injury, such as multiple piercing.
When to Seek Medical Care
Seek medical evaluation if keloids become bothersome or symptomatic.
Treatments Your Physician May Prescribe
Keloids are extremely difficult to treat, but your doctor may try the following:
- Some keloids respond to topically applied silicone sheeting.
- There has been some success in treating small earlobe keloids with pressure or "clip-on" earrings.
- Inflamed keloids often respond to steroid injections near the site. There is a risk of thinning of the skin (atrophy) with steroid injections.
Alternative therapies include:
- Freezing (cryosurgery) plus steroid injections.
- Surgery plus radiation therapy to the affected area. Surgical removal (excision) of keloids may lead to the keloid coming back (recurring) larger than it was before the excision.
- Laser therapy with a pulsed-dye laser to actively expanding lesions.
- Other injectable agents, such as interferon alpha and gamma.
Bolognia, Jean L., ed. Dermatology
, pp.1531-1535. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine
ed, pp.991-992, 2475. New York: McGraw-Hill, 2003.