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.