Keloids and Keloidal Scars

Keloids are scars that have become larger, raised, and lumpy.  They occur when the skin tries to repair itself from an injury but does not heal properly.  We all have fibroblasts in our skin and those form the fibrous tissue that gives strength to the skin.  But in a keloid the skin doesn’t just form just the normal amount of fibrous tissue and instead forms too much.

This overgrowth of fibrous tissue in the keloid can cause a number of problems.    Keloids often cause pain, burning sensations, and tenderness on pressure.  The fibrosis in keloids causes a feeling of tightness and restriction of motion.   In addition, keloids can look unsightly and have a lumpy or clawed appearance.

We don’t know exactly what causes keloids to form, but we do know some things about them.  Keloids occur in all skin types, but they occur more frequently in darker skin.  They can occur on most areas of the body, but some areas are more susceptible, including the chest, shoulder, and jaw.  One of the most frequent areas is the earlobe, after piercing the ear.

Another area where keloids often develop is the back of the scalp on black men.  There the hair can ingrow and cause irritation.  This is called pseudofolliculitis and is similar to Pseudofolliculitis Barbae (PFB) in the beard area.  The irritation can then cause keloids, causing a Keloidal Folliculitis.  This can progress with inflammation, pus, infections, more scarring and eventually permanent hair loss.

Mild Keloidal Folliculitis
Moderate Keloidal Folliculitis
Severe Keloidal Folliculitis

Treatment of Keloids

Because keloids are relatively common and can be very symptomatic, people have tried many kinds of treatment for them.  The major treatments are surgical removal (cutting them out) and injections of steroids.  Other kinds of treatments include compression, radiation, and topical applications but those have not worked as well.

Surgical excision can be useful for some kinds of keloids.  But frequently the keloids can recur and be larger or worse than they were originally.  So this treatment must be approached carefully and have careful follow-up.

Intralesional injection is done by multiple injections into the keloids.  We generally do this at intervals of about 3 weeks or so and this treatment can work very well.  The injections have to be done correctly and usually the keloid will first become softer and then decrease in size.  Sometimes we combine injections with surgical removal.

The following sequence shows the results of treatment of a keloid on the ear.
Pre-Treatment
During Treatment
After excision and intralesional injections

 

Before
After Treatment

What our patients have to say...

"Dr Steinberg did a very good job on my ears and he always had time to talk with me and my wife. I thank him so much; he's been a blessing for me. Thank you, Dr Steinberg."

- J.M., after treatment for keloids -

 

We prefer to treat keloids earlier, as they occur, to try to get quicker results. So please call the Advanced Dermatology Center at (706) 323-1000 to arrange that.

Advanced Dermatology Center of Columbus- Dr Thomas Steinberg MD

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