Family Medicine — Keloid scars not dangerous

Question: I had a benign growth removed from my chest about six months ago, and now I have this really big, ugly, pink scar that keeps growing. Someone told me it’s a “keloid.” Is it dangerous? Should I go back and have it removed?

Answer: Keloid scars are an overgrowth of collagen, the substance that helps wounds heal. They are benign but can cause some discomfort and cosmetic distress. Keloids, like all scars, occur where skin has been cut or damaged by anything from an accident or a surgical procedure to a body piercing or acne.

The body produces collagen just below the top layer of skin to fill in breaks in the skin. Normally, collagen “knows” when it’s no longer needed. But some people keep producing collagen, so the scar keeps growing. If the overgrowth follows the boundaries of the original injury but is slightly raised, the resulting scar is called a hypertrophic scar, and these often fade over time. But if the scar extends both up and beyond the original injury, it’s deemed a keloid.

Keloids are generally shiny, pink and dome-shaped, and they’re usually firm. They seem to run in families and are more common in people of African and Asian descent. Keloids can occur anywhere on the body but are most common on the chest, upper back, shoulders and earlobes (after piercing). A keloid may form one time but not another. Usually, keloids cause no symptoms, but some people experience itching and tenderness while they’re growing.

Aside from the appearance of the keloid, itself, another cosmetic issue is dark pigmentation that occurs if the scar is overexposed to sun within the first year it’s forming. The scar will tan darker than the skin around it, and usually, the difference in color is permanent.

I tell my patients to put a patch or band-aid over the scar if they’re going to be in the sun. While this, too, will result in a scar that is a different color than the skin around it, at least it’s a temporary difference, and the skin tones should even out the following year. And remember: scar or no scar, you should always use a high SPF sunscreen.

In more than 50 percent of cases, surgery to remove keloids results in increased scarring, but advances are being made to improve this number. It is very difficult to completely remove a keloid. Cortisone injections can help flatten it. These are repeated monthly. Cryosurgery – freezing with liquid nitrogen – may also help flatten the scar, but it also can discolor the skin. Some physicians have used lasers to treat keloids, but the outcomes have not been stellar. Some are also trying lasers plus cortisone.

 Finally, there are some over-the-counter products, such as silicone sheeting, that have shown good results, but only with very long-term treatment.

Ask your family doctor about the scar. He or she may recommend that you see a dermatologist or plastic surgeon.

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Scars, We have Them

I was just reading a thread about incision scars on the Adults With Congenital Heart Disease Association's message board. One of the posters was talking about using Palmer's Skin Therapy Oil on her newest scar (just had surgery 6 weeks ago). She is one who seems to "fret" about the appearance of the scar. Now I've had mine for more than seven years. It's a bit keloid toward the bottom, but I don't show off that part to the general public. The top part of the scar is light pink and think. It's barely noticeable if I wear a lower-cut shirt. Heck, I can usually tell a change in the weather by my scar. I did try a type of cream once on it, smelled like cocoa. In fact, I swear I smelled like a chocolate bar. I only tried this massage technique by using a pencil eraser once. It kinda squicked me out. So I live with the scar. I'm not crazy about getting injections to reduce it, surgery to make it basically disappear or spending x amount of dollars on a scar treatment or cream. It's a part of me and will be for years to come.

What are the signs and symptoms of keloids?

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.

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, by contrast, may start some time after the injury and extend beyond the wound site. This tendency to migrate into surrounding areas that weren't injured to begin with 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.