Keloid

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Overview

Keloids are dense, thick nodules, typically found at areas of previously injured skin (burns, cuts), 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, and grow to become very large, up to 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 after puberty. Younger children may be affected as well.
  • Keloids are most frequent in individuals of African and Mediterranean ancestries, but they can appear in people of every 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 middle of the chest.

  • Keloids are smooth and shiny, firm to the touch, red or skin-colored nodules with regular or irregular ridges.
  • Keloids may develop projections that extend beyond the area of injury.

Self-Care Guidelines

None necessary except to avoid unnecessary trauma, such as cosmetic skin piercing.

When to Seek Medical Care

See your child's doctor for 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 use of "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:

  • Cryosurgery (freezing) plus steroid injections.
  • Surgery plus local radiation therapy; surgical excision of keloids is inevitably fraught with the possibility of the keloid recurring in larger size than before the excision.
  • Laser therapy with a pulsed dye laser to actively expanding lesions.
  • Other injectable agents, such as interferon alpha and gamma.

Trusted Links

Clinical Information and Differential Diagnosis of Keloid

References

Bolognia, Jean L., ed. Dermatology, pp.1531-1535. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.991-992, 2475. New York: McGraw-Hill, 2003.