When a Scar Won't Stop Growing: A Guide to Understanding and Treating Keloids

We all have scars. They are the little souvenirs of life’s misadventures—a fallen bike, a kitchen slip, or a childhood surgery. Usually, a scar is a neat, faded reminder of a wound that has healed. But what happens when the body's healing process goes into overdrive? For some, a simple cut or piercing can transform into a raised, rubbery growth that extends far beyond the original injury. This is the reality of a keloid.

Unlike a typical scar, a keloid doesn't know when to stop. It's a stubborn and often frustrating condition, but understanding it is the first step toward managing it.

The Body's Overzealous Repair Crew: Why Keloids Form

At the heart of every scar is collagen, a fibrous protein that the body uses to repair skin. In a standard wound, the body produces just enough collagen to close the gap. With a keloid, however, this process is flawed. The body continues to pump out collagen long after the wound has healed, creating a dense, fibrous lump that rises above the skin's surface.

So, what triggers this overreaction? The exact mechanism isn't fully understood, but it always begins with some form of skin trauma. This can be anything from a minor cut, scrape, or burn to more significant injuries like surgical incisions, severe acne, chickenpox scars, or even body piercings and tattoos. In rare cases, keloids can appear spontaneously without any obvious injury.

Recognizing a Keloid: More Than Just a Raised Mark

Identifying a keloid is often straightforward. Its key characteristics include:

• Appearance: A raised, smooth, and hard growth that can be flesh-colored, pink, red, or much darker than the surrounding skin.
• Growth: Unlike other scars that may shrink over time, a keloid can continue to grow for months or even years.
• Sensation: The area can be itchy, tender, or even painful to the touch.
• Location: While they can form anywhere, keloids are most commonly found on the chest, shoulders, upper back, earlobes, and cheeks.

Who Is at Risk? Uncovering the Predisposition

Keloids don't affect everyone equally. Knowing the risk factors can help you be more vigilant:

• Genetics and Skin Tone: Keloids are significantly more common in individuals with darker skin. People of African, Asian, and Hispanic descent have a much higher predisposition. If you have a family history of keloids, your risk is also elevated.
• Previous Keloids: Once you've developed a keloid in one area, you are more likely to form another from a new injury.
• Age and Hormonal Changes: They are most common in people between the ages of 10 and 30, potentially due to hormonal activity.

Taming the Growth: Strategies for Keloid Management

Treating a keloid is challenging because removing it can sometimes trigger the body to grow an even larger one in its place. Therefore, the goal of treatment is typically to flatten the scar, reduce its size, alleviate symptoms like itching and pain, and improve its appearance. A dermatologist can help you choose the best approach, which often involves a combination of therapies.

Non-Invasive and Medical Approaches:

• Corticosteroid Injections: This is a frontline treatment. Injecting corticosteroids directly into the keloid helps to reduce inflammation, flatten the scar, and soften its texture. Multiple sessions are usually required.
• Silicone Gels and Sheets: Applying silicone gel or sheets over the keloid helps to hydrate the tissue, which can reduce redness, flatten the scar, and relieve itching. This is a simple, painless option often used alongside other treatments.
• Cryotherapy: This technique involves freezing the keloid tissue with liquid nitrogen. It's often used in combination with steroid injections to help reduce the scar's size and hardness.
• Laser Therapy: Pulsed-dye lasers can reduce the redness and flatten the keloid, improving its overall appearance.

Surgical and Advanced Options:

• Surgical Removal: A surgeon can cut out the keloid. However, this carries a high risk (up to 50-100%) of the keloid returning, sometimes larger than before. Surgery is therefore almost always followed by additional treatments, such as steroid injections or radiation, to prevent regrowth.
• Radiation Therapy: Low-dose radiation applied immediately after surgical removal can significantly reduce the chances of the keloid returning.
• Pressure Therapy: Applying constant pressure to the area, often with specially designed garments or clips for earlobe keloids, can help prevent regrowth after treatment.

The Best Defense: Preventing Keloids Before They Start

If you know you are prone to keloids, prevention is your most powerful tool.

1. Avoid Unnecessary Trauma: Think twice before getting piercings, tattoos, or cosmetic surgeries, especially on high-risk areas like the chest and shoulders.
2. Treat Wounds Promptly: Clean all cuts and scrapes thoroughly to prevent infection, and avoid picking at scabs as the wound heals.
3. Be Proactive with New Scars: If you get a new wound or surgical incision, talk to your doctor about using silicone sheets or gel early in the healing process to help regulate collagen production.
4. Inform Your Doctors: Always tell your doctor or surgeon if you have a history of keloids. They can take special precautions, like injecting steroids into the site during surgery, to minimize the risk.

Living with a keloid can be a journey of patience and persistence. While a one-time "cure" is rare, modern treatments offer effective ways to manage the condition, reduce its impact, and restore confidence in your skin. If you suspect you have a keloid, the best first step is to consult a board-certified dermatologist to create a personalized management plan.