What are the other Names for this Condition? (Also known as/Synonyms)

• Keloids
• Keloidal Scar

What is Keloid Scar? (Definition/Background Information)

• Generally, as the body heals from an injury, a scar is formed. The scar is confined to the area of injury
• Sometimes the response of the body to the injury results in scar tissue formation which is in excess of the magnitude of the injury. This results in a scar that extends much beyond the site of injury
• Keloid Scars are benign proliferations of scar tissue that causes abnormal scarring; it does not remain confined to the region of injury, but grows beyond it
• Keloidal Scars result in cosmetic issues and functional problems. They may be surgically removed. They are known to recur frequently

Who gets Keloid Scar? (Age and Sex Distribution)

• Keloid Scars usually occur in individuals in their late 20s and 30s. The tendency to form such scars decreases with age
• They are common in both males and females
• Keloid Scars are more frequently seen in certain pigmented individuals such as African Americans, Hispanics, and Asians

What are the Risk Factors for Keloid Scar? (Predisposing Factors)

The potential risk factors for Keloid Scars include:

• Being an African American, Hispanic, or of Asian origin increases the risk of developing keloids. Certain genetic factors have been attributed to explain a predominance of these scars
• A family history of Keloid Scars
• Individuals who have autoimmune disorders, such as asthma and allergies, are at an increased risk
• A Keloidal Scar can get worse during pregnancy and also during puberty. This may be due to the influence of hormones

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes for Keloid Scar? (Etiology)

The exact cause of development of Keloid Scars is presently unknown.

• Not all keloid scars have a noted traumatic origin
• Genetic and hormonal factors have been implicated in the development of these scars
• Abnormal functioning of fibrous tissue in the body is a probable cause for the formation of Keloidal Scars

What are the Signs and Symptoms of Keloid Scar?

The signs and symptoms of Keloid Scars include:

• Development of excessive scar tissue in the area of injury
• The scar tissue is firm and raised; the surface of the scar tissue is smooth. In some individuals, these may be darkly-pigmented
• Keloid Scar tissues may be painful and itchy
• A history of trauma is usually present. The trauma may have been trivial in relation to the keloid formed
• The common sites for formation of keloids include the face, earlobes, arms, and back
• The traumatic event of ear-piercing is commonly noted on earlobe keloids
• Surgical scars can also lead to Keloid Scars
• It is uncommon to see Keloidal Scars in the genital areas, palms of the hands, and soles of the feet. It is also rare to find them around the eyes

How is Keloid Scar Diagnosed?

Keloid Scars may be diagnosed as follows:

• A thorough medical history and physical examination
• Biopsy of the scarred region: Examination of the biopsy by the pathologist under a microscope can reveal the presence of increased scar tissue
• A pathological examination helps distinguish a Keloid Scar from a hypertrophic scar in a majority of cases

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Keloid Scar?

The possible complications of Keloid Scar include:

• The scars usually cause cosmetic issues
• Keloids can be painful on pressure
• They may be itchy and occasionally cause an ulceration of the overlying skin. In such cases, the skin may get infected causing further complications
• Recurrence of the condition after surgical excision and removal

How is Keloid Scar Treated?

Many options are available for the treatment of Keloid Scars. Large studies leading to definitive guidelines are rare.

• The most frequent treatment is intralesional injection of corticosteroids. High concentrations are used with monthly repeat injections. The doses used are low enough to not have systemic side effects
• Topical noninvasive treatments can be helpful, but compliance must be high. Topical petrolatum, silicon gels, silicon sheets, vitamin E, and onion extracts are used
• A surgical excision of the Keloidal Scar is frequently done. The patient must be aware of the high risk of recurrence. At the end of the surgery, intralesional corticosteroids are injected. Wound care is explained. The patient then returns for monthly injections to the surgical site, in order to decrease recurrence rates
• Some surgeons refer patients immediately post-operation to radiation therapy. A very small dose of radiation directed just at the surgical site can decrease the recurrence rate
• Pulsed dye laser and other vascular-directed lasers can assist in keloid prevention
• Fractional lasers which vaporize only portions of the scars are sometimes used

How can Keloid Scar be Prevented?

• It is difficult to prevent the formation of a Keloid Scar
• Prompt treatment may help in decreasing the amount of scar formation
• Prevention and treatment of Keloid Scars is a field that requires significantly more scientific study

What is the Prognosis of Keloid Scar? (Outcomes/Resolutions)

The prognosis of Keloid Scar with appropriate treatment is generally excellent. They are known to recur at a rate of over 75%.

Additional and Relevant Useful Information for Keloid Scar:

Keloidal Scars should be distinguished from hypertrophic scars:

• In Keloidal Scars, the scar tissue is formed beyond the region of injury
• In hypertrophic scars, the scar tissue is excessive but is confined to the region of injury