What is a keloid?
Keloids can be considered to be "scars that don't know when to stop." A keloid, sometimes referred to as a keloid scar, is a tough heaped-up scar that rises quite abruptly above the rest of the skin. It usually has a smooth top and a pink or purple color. Keloids are irregularly shaped and tend to enlarge progressively. Unlike scars, keloids do not subside over time.
What is the difference between a keloid and a hypertrophic scar?
After the skin is injured, the healing process usually leaves a flat scar. Sometimes the scar is hypertrophic, or thickened, but confined to the margin of the wound. Hypertrophic scars tend to be redder and may subside by themselves (a process which can take one year or more). Treatment, such as injections of cortisone (steroids), can speed this process.
Keloids are benign (noncancerous), fibrous skin tumours. They are most common in people with darker skin (e.g., people from West Africa or Southern India) and people usually develop them between the ages of 10 and 30. Both men and women are equally likely to have keloids.
Keloids, by contrast, may start sometime after the injury and extend beyond the wound site. This tendency to migrate into surrounding areas that weren't injured originally distinguishes keloids from hypertrophic scars. Keloids typically appear following surgery or injury, but they can also appear spontaneously or as a result of some slight inflammation, such as an acne pimple on the chest (even one that wasn't scratched or otherwise irritated). Other minor injuries that can trigger keloids are burns and piercings.
Causes of Keloids
Keloids usually occur at the site of skin damage (e.g., acne, burns, chicken pox, cuts, insect bites, piercings, surgery, tattoos, vaccinations), although they can occur spontaneously. Whether or not a keloid will form is not determined by the severity of the wound - even a minor skin abrasion can result in keloid formation.
Keloids are the result of abnormal wound healing. Normally, there is a balance between the production and the breakdown of collagen, which is a protein that makes up the fibres in the skin. With keloidal scars, the cells in the skin called fibroblasts produce excessive amounts of collagen. The collagen fibres are also thicker and wavier. This leads to the thick, raised appearance that is characteristic of keloidal scars. It is unclear what prompts this unusual healing process. Possible causes include genetic factors, skin tension, skin colour (they are more common in those with darker skin tones), and the presence of a very high number of fibroblasts in the skin.
What are keloid symptoms and signs?
Keloids are raised and look shiny and dome-shaped, ranging in color from pink to red. Some keloids become quite large and unsightly. Aside from causing potential cosmetic problems, these exuberant scars tend to be itchy, tender, or even painful to the touch.
Keloids are more likely to develop on the arms, back, ears, lower legs, mid-chest, and neck. They may form as a wound heals, or they may take several months or even years to develop. Rarely, they will continue to grow indefinitely.
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