Keloid scars are common thick raised scars that often appear on the ear lobes, cheeks, shoulders, and chest. They can, however, occur in any other part of the body. Keloids often grow on the skin after an injury or surgery. But what causes a keloid scar? Generally, it occurs when the body produces too much collagen, an important protein for wound healing. However, there’s more to why this can be so.
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This article takes you through what causes keloid scars, including risk factors, symptoms, and treatments to ensure it doesn’t happen again in the future.
What is a keloid?
A keloid or keloid scar is an unsightly lumpy or ridged, overgrown scar tissue that arises from an injury to the skin after it has healed.
This is usually due to an overproduction of collagen, leading to excessive tissue formation.
Unlike other scars that heal and fade away with time, keloid scars grow larger than the wound that formed the scar.
After you injure yourself, it can take weeks, months, to years before you see a keloid appear, and when it does, it can grow slowly for months or years and, with time, become bigger than the original wound.
The scar may feel itchy or painful during this period, but it often stops once the keloid tissue stops growing.
Usually, the condition is not life-threatening and may not cause any adverse effects; however, it can feel itchy and sometimes painful.
It can also affect your emotional stability and well-being, especially if the keloids occur in visible areas like the cheeks or earlobes.
Keloids don’t usually go away on their own and can be challenging to treat. Nonetheless, they may not require any treatment unless they are causing discomfort.
Hypertrophic Scars vs. Keloids
Both hypertrophic scars and keloid scars occur as a result of excessive scar tissue formation causing one to think they are the same, but they are not.
While keloids can grow beyond the original injury site, hypertrophic scars grow within the injury site and don’t extend past the original boundaries of the wound.
What Causes a Keloid Scar?
The exact cause of Keloid scars is not known but they can be triggered by any injury or an invasion of the skin, including through
- Body piercing (especially ear piercing)
- Insect bite
- Hair removal
- A wound caused by surgery or any procedure
- A deep wound, like a puncture wound
- Others can develop keloids from shaving their beard area
When this happens, the fibroblasts (cells that produce collagen) act out of control, producing too much collagen for wound healing.
Collagen is a structural protein that stimulates new tissue growth and acts as a building block to bring a wound back together. However, when the collagen is overproduced, keloids can form.
Why do some people get keloid scars and others don’t
While what happens inside the body to bring about keloids is still being studied. Scientists have discovered consistent results in people with certain factors, such as
1. A positive family history
Most people that get keloids have a first-degree relative (child, father, mother, sister, brother) that has had keloids.
According to the American Academy of Dermatology, black people are more likely to develop keloids than white people due to their high melanin content.
People from other ethnic backgrounds with darker skin tones, like Latin Americans, may also have an increased risk.
In Asia, the Chinese have the highest risk of developing keloids.
One study found that dark-skinned individuals form keloids 15 times more frequently than light-skinned people.
When scientists tried to figure out why this was so, they discovered that when a black person injures themselves, there are more melanocytes (the cells that makeup melanin) in the injured area, leading to more melanin production. This means keloids are more in the regions that produce the pigment, such as the chest, than the lesser areas, such as the palm of the hand.
Keloids are more common between the ages of 10-30 years, but most people begin seeing them at age 20. They, however, can still occur outside this age bracket.
An analysis of 1569 patients in Japan found that women were more prone to developing keloids than males.
This was linked to the fact that females care more about their appearance and are more likely to engage in activities contributing to keloid formation, such as ear piercing and cosmetic procedures.
People with high blood pressure may also be at risk of developing keloids. This is because high blood pressure can damage blood vessels leading to local tissue injuries and inflammation.
Why do some keloids form without injury?
Keloids that form without an injury are called spontaneous keloids. These are very rare, but they often occur without any history of trauma or injury.
Researchers believe they occur as a result of minimal cutaneous inflammation (skin inflammation) or triggered microtrauma (an injury resulting from repetitive stress to tissues) in genetically predisposed individuals.
These kinds of keloids can also form as a result of taking certain medications.
How are Keloids Diagnosed?
A dermatologist usually diagnoses keloids through a physical examination of the affected area.
They’ll check for the shape, size, and growth pattern of the scar just to ensure it’s not a hypertrophic scar.
As mentioned earlier, a hypertrophic scar will contain its shape and margins within the injury, while a keloid scar is irregular and can often extend its margins beyond the injury site.
Before the physical exam, your doctor will ask about your medical history, including if you have had any surgeries on the site, if there was an injury, etc. They may also ask about your family history and whether anyone in the family has keloids.
If there’s a doubt about whether the scar is a keloid scar or something else, your doctor may request a biopsy.
Treatments for Keloid Scars
While you can comfortably live with a keloid and not require treatment, it may impact the self-esteem of some individuals.
Some scars may also cause discomfort, such as itching or impaired mobility if it’s located around a joint.
In such cases, the doctor may suggest a treatment to help reduce the size or prominence of the scar.
Treatments may range from medications to surgical and non-surgical procedures. They’re also home remedies that have been shown to help.
Intralesional corticosteroid injections
These injections are given directly into the keloid to help fight inflammation and constrict blood vessels. This can help relieve itchiness, swelling, and even pain.
Multiple injections may be needed for optimal results.
Retinoids have been shown to affect collagen metabolism, and a topical application may reduce the appearance of keloid tissues and itchiness.
However, precaution is needed as the retinoic acid in retinol may reduce collagenase production. Collagenase is an enzyme that helps break and remove dead skin and tissues, which may speed up the body’s natural healing process.
Silicone gel or sheet
Topical silicone gel or sheet is considered the first-line treatment for keloids and hypertrophic scars. They are also the most recommended and cosmetically acceptable methods to soften and flatten keloid scars or hypertrophic scars.
In fact, silicone dressings have been used since 1989 to treat hypertrophic scars and keloid scars and are still being used today.
Here your doctor will use a surgical thread to tie around the keloid. This cuts off the blood supply causing the keloid to die and fall off naturally.
This is a new treatment modality that involves the use of high-energy light beams to flatten larger keloids and relieve itchiness.
The common laser therapy used includes pulsed-dye laser therapy. This method has also been effective in relieving itchiness.
The laser therapy is often delivered in sessions (4-8 weeks between sessions) until you finish the recommended sessions. This laser therapy is often combined with other methods like corticosteroid injections for optimal benefits.
Here the keloid scar is surgically removed, followed by low-dose radiation to prevent a recurrence.
This involves using compression dressing or any other device to apply pressure to the area, aiming to reduce blood flow to the site, which prevents keloid regrowth.
This method also helps reduce or prevent scar formation after surgery as the wound heals.
According to research, pressure therapy alone or combined with surgery has shown effectiveness in treating keloids.
This method may, however, be difficult to follow as it can be uncomfortable, plus one needs to wear the pressure devices for 6-12 months.
This method involves the use of liquid nitrogen, carbon dioxide, or argon gas to freeze the keloid tissue. This decreases blood flow to the area causing it to die.
This method is more beneficial for small keloids of recent onset.
Natural Remedies for Keloid Scars
Besides the conventional approaches, there’re several home remedies that have been shown to help.
Topical application of garlic to the scar has been shown to block certain enzymes responsible for tissue growth and pigment buildup that leads to scar formation.
Garlic also reduces inflammation and promotes scar healing which, with time, will start to fade.
To use garlic:
- Crush garlic cloves to form a paste.
- Apply to the scar and leave for 15 minutes before rinsing it off.
- Repeat twice daily for effective results.
You can also apply garlic oil to the scar tissue and leave it on for 30 minutes. Rinse off and repeat twice daily.
Aspirin is a widely used nonsteroidal anti-inflammatory drug, NSAID.
Research has found that it can reduce the appearance of keloid scars as well as their size by preventing scar-forming cells from entering the keloid site.
To use aspirin, crush 3-4 tablets into powder, add water, and mix to form a paste. Apply it to the keloid or wound site and let it sit for 1-2 hours before rinsing. Do this once daily until you achieve your desired results.
Honey is another natural remedy full of antibacterial and anti-inflammatory compounds that may reduce keloids and prevent secondary infections in wounds.
Before you use any honey, ensure it’s natural with no added sugar.
Apply a good amount of honey to cover the scar and let it sit until the honey becomes sticky, then wash it off.
Repeat this several times or at least twice a day for better results.
Aloe vera gel
Aloe vera gel is a powerful anti-inflammatory ingredient often used to treat skin conditions.
It’s also a natural antibacterial and antiseptic. All these factors can help reduce the keloid scar and ease itchiness.
One study found that a silicon gel containing aloe vera and onion extract effectively prevented post-operative hypertrophic scars.
Several studies have reported positive results on the use of onion for keloid treatment and reduction.
When to See a Doctor
If you have a keloid scar, it’s important to know when to pay a visit to the doctor.
For example, if the keloid is large and causing pain, you may want to visit a doctor.
Also, if the keloid is getting bigger and you’ve tried home remedies without success, you should consider visiting a doctor.
Lastly, if your keloid is reddened or purple in color, tender to touch, bleeding, or oozing pus, that’s a sign that there’s an infection and you need immediate treatment.
How to Prevent Keloids
If you’ve had keloids before or are predisposed i.e, through a positive family history, it’s good to know what you can do to prevent future occurrences.
This may include:
- Avoid body piercing and tattoos.
- Avoid pimple popping and skin pricking.
- Avoid cosmetic surgery.
- In case you have a wound, ensure proper wound care with the help of a healthcare provider.
- Get any injury treated immediately. Delaying treatment can cause poor healing and with increased risk of scaring.
Keloid scars are a common skin condition, but understanding what they are and what causes them is important to prevent their occurrences.
And in case you have one, it’s good to understand that they don’t pose any health risk or call for concern.
They, however, might cause some discomfort, such as itching, which you can easily curb with the natural remedies discussed above.
Nonetheless, if your keloid scar is rapidly growing, it’s good to visit a dermatologist for a way forward.
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