Scars come in many different textures, colors, and sizes. Many scars become smaller, smoother, and less noticeable with time.
But for about 10 percent of people, even minor injuries can create scars that are excessively large, raised, and dark in color.
They extend far beyond the original injury to the skin and may continue to grow with time. These types of scars are known as keloids.
Fast facts on keloids:
- Keloids can be a concern due to their appearance, particularly if on the face, neck, or hands.
- There’s no foolproof way to get rid of keloids.
- A keloid forms as a result of an exaggerated healing response in some people, especially those with more pigment in their skin.
- Prescription medicines and in-office procedures may be able to improve the appearance of keloids.
Why are keloids an issue?
Unlike most scars, keloids do not regress over time.
Though unsightly, people with keloids may have concerns that go beyond aesthetics. Keloids can cause discomfort, tightness, or even limited range of motion if they occur near a joint, such as the knee or ankle.
The excessive stretching of the skin can cause itching, and because of their larger size, keloids are prone to rubbing on clothing, causing irritation.
Like any scar, keloids can be tricky to treat. But, medical advances are being made in keloid treatment that may hold promise.
Preventing keloids through proper wound care and avoiding injury to the skin, such as piercings, is the best strategy for people who are prone to getting keloids.
Why do keloids form?
A keloid forms due to the skin’s exaggerated response to an injury. Even minor cuts can cause keloids. Some of the most common causes of keloids include:
- cuts or punctures, including from shaving
- incisions from surgery
- insect bites
- skin conditions, such as acne
chickenpox or diseases that cause scarring of the skin
- tattoos or piercings
Some keloids form without any apparent cause. A review in the Journal of Medical Investigations and Practice states that some keloids have been known to appear without the presence of a skin injury. They may also crop up years after an injury has taken place.
When the skin is injured, it sends collagen-making cells to heal the wound. Ideally, the cells do their job and close the injury, leaving a small scar. With keloids, the skin’s cells continue to multiply even after the wound has healed. The scar tissue continues to grow, forming a large, raised scar.
Though keloids can occur in any skin type, they are more likely to form in:
- those who have a family history of keloids
- people under 30, especially teenagers going through puberty
- pregnant women
- people with darker skin tones, such as those people of Asian, Hispanic, or African-American descent, are also more likely to develop keloids than other people.
Keloids are considered to be a type of benign tumor. Though they can be bothersome, they do not turn into cancer or pose serious health problems.
Keloids and piercings
Using non-metal earing backs may help to prevent keloids from forming after ear piercing.
Keloids often develop after piercings. Whether they occur more frequently after piercings as opposed to other skin injuries is unknown. They are more prevalent on the earlobes than on other parts of the body, but this is probably because the earlobes are a popular location for piercings.
Though preventing keloids is not always possible, there may be a few ways to reduce the risk of getting one after a piercing:
Use non-metal earring backs
A study in the Australasian Journal of Dermatology examined the reason why keloids tend to form more frequently on the back of the earlobe after an ear piercing. They determined that earrings with metal backs more often led to keloids on the back of the earlobe.
As such, they suggest that using non-metal earring backs could be a way to reduce the chance of getting a keloid on the back of the earlobe after a piercing.
Piercings and age
A study in AAP News & Journals found that keloids from ear piercings were more common in children who got their ears pierced after 11 years of age. The incidence of keloids after ear piercings was much lower in children under 11 years old.
The authors suggested getting the piercing before 11 years of age, or avoiding ear piercing if there is a family history of keloids.
Once you have them, keloids are notoriously difficult to eliminate and have a very high chance of re-growing once they are surgically cut out. This is because the body is likely to respond in the same exaggerated way to this surgery as it did to the initial injury.
Treating keloids at home
No home remedies have been shown to get rid of keloids once they have formed. But, there are a few things that people can do at home after a skin injury to help prevent keloids from forming or minimize their appearance.
Silicone sheeting or gel
Silicone is one of the most widely used scar remedies, and it has been proven to help shrink some raised and keloid scars. Silicone has a low risk of adverse effects and is easy to use.
Reviews published in Aesthetic Plastic Surgery and the Journal of Cutaneous and Aesthetic Surgery confirm that applying silicone sheeting or gel as advised can provide an effective way to shrink existing raised scars or help keep them from forming.
A heavy skin cream or lotion
A review in the International Journal of Cosmetic Science states that some skin products, such as those that contain lanolin or petrolatum, may improve a scar’s appearance. People should use the creams regularly and cover the scar as the wound is healing.
Although creams containing onion extract or Vitamin E are widely used for scars, a review in American Family Physician and a study in Dermatologic Surgery found that these ingredients have not been shown to help with keloids.
Tretinoin cream (Retin-A)
Temporarily freezing tissues with cryotherapy may help to reduce the appearance of keloids.
Tretinoin is a prescription medicine that people apply to their skin. Commonly used for acne and aging, it works by speeding up the skin’s natural cell turnover.
A 2010 review in the Journal of Clinical and Aesthetic Dermatology found that retinoids, such as tretinoin cream and isotretinoin, may help reduce the size and appearance of keloids.
Cryotherapy is a process that involves temporarily freezing the tissues with a handheld device. Most people tolerate the therapy well, but some people may experience severe pain during the procedure that goes away afterward.
A small study published in the Journal of Cutaneous and Aesthetic Surgery suggests that after several treatments, cryotherapy can reduce the size of keloids by up to 50 percent. But, the study also states that cryotherapy works best on smaller keloids that are less than 3 years old.
This treatment has been used for years on keloids with some success. A study in the Journal of Medical Investigations and Practice stated that injected steroids are an effective way to reduce the size and appearance of keloids.
A review in American Family Physician states that steroid therapy works best on newer keloids and when combined with surgery to remove part of the scar. It can also be used in conjunction with cryotherapy.
This cream is used to treat a variety of skin lesions, including superficial basal cell skin cancers. It appears to work well on the skin after a keloid has been removed. A review in the Journal of Oral and Maxillofacial Surgery found that the cream reduced the chances of a keloid coming back.
A newer treatment that is showing promising results involves a short course of radiation therapy, which is given immediately after surgically cutting out the keloids. Several studies in the plastic surgery and dermatology literature show a high rate of cure, or at least improvement, in keloid scars in people treated by this method.
Because keloids are difficult to treat, it is best to take steps to prevent them immediately after an injury, surgery, or piercing. People who are prone to keloids may wish to avoid tattoos and piercings altogether. If someone requires surgery for any reason, they should make their doctor aware of any history of keloids so prevention can begin soon after the surgery.
Though keloids do not pose a health risk, they can be emotionally and mentally damaging. Some treatments are available, but no single treatment works for all. People will need to discuss keloid removal options with their doctor and determine the best course of action to take.