By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

KELOIDS TEND TO BE HEREDITARY, TREATMENT OFTEN PROBLEMATIC

Question: I had a benign growth removed from my chest about six months ago. Now I have this really big, ugly, pink scar that seems to keep growing. Someone at work said this is a keloid. What is that? Should I go back to the surgeon and have it removed?

Answer: You’re right when you refer to a keloid as a scar that “seems to keep growing.” Put another way, a keloid is a scar that doesn't know when to stop. Normally, after an injury the cells grow back in an orderly fashion. This doesn’t always happen with people who are prone to keloids.

In normal wound healing, collagen is produced just below the top layer of skin, or dermis, to fill in the gap caused by the trauma. Chemical messages of some sort apparently tell the body to stop producing the collagen when the gap is filled in. In some people, however, these cells either don’t get the message or don’t respond to it, and they cause an overgrowth of scar tissue. If the overgrowth is confined to the actual site of injury, it is called a hypertrophic scar. If the scar keeps on getting larger and extends beyond the site of injury, it is considered a keloid.

Keloids can be the result of an accidental injury to the skin or an injury that results from a surgical procedure. These irregularly shaped scars are generally shiny, pink and dome-shaped. They are raised above the skin and are usually firm to the touch. They run in families and are more common in people of African and Asian descent. While a keloid can occur in any part of the body, they are more common on the chest, upper back and shoulders. A common site is the earlobe after piercing. Interestingly, however, a person may form a keloid after one skin injury but not after another, even if the injuries are on the same part of the body. The explanation for this is currently unknown. While most keloids are asymptomatic, some people experience itching and tenderness.

As for the treatment of keloids, additional surgery frequently results in increased scar formation. There are some remedies that can be helpful, but bear in mind it is extremely difficult to completely remove a keloid.

Cortisone injections into the keloid can help flatten out the scar. These need to be repeated monthly. Cryosurgery, freezing with liquid nitrogen, may also help to flatten out keloids but can discolor the skin. Cryosurgery can be used either alone or in conjunction with cortisone injections. Some physicians have used lasers to treat keloids, but the outcomes have not been stellar. Others have tried lasers plus cortisone. There are some over-the-counter products, such as silicone sheeting, that have shown good results. The treatment period, however, is very long.

Discuss this problem with your family doctor, and he or she may recommend a consultation with a plastic surgeon. Check to see if other family members have large scars. This probably runs in your family.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.