What are keloids?
Keloids are overgrowths of scar tissue that form at the site of a skin injury. They are benign skin growths that extend beyond the boundaries of the original wound and do not regress over time. Keloids can form anywhere on the body but are most common on the chest, shoulders, ears, and back. They are more prevalent in people with darker skin tones. Keloids tend to be firm, rubbery lesions that are slightly raised and reddish purple in color. The surface is usually smooth and shiny.
What causes keloids?
The exact cause of keloids is unknown, but they are thought to be the result of an overaggressive healing process. Keloids form when there is excessive collagen (scar tissue) production during wound healing. Collagen is a protein that provides structure and strength to skin. In keloids, collagen accumulates and organizes into dense fibrous tissue that grows beyond the boundaries of the original injury.
Keloids tend to run in families, indicating there may be genetic factors. Certain genes involved in wound healing and inflammation are linked to increased risk of keloids. Darker skinned individuals are 15 times more likely to develop keloids. The tendency to form keloids decreases with age. People aged 10-30 years are most susceptible.
Why are keloids problematic?
Keloids can cause cosmetic concerns due to their abnormal growth patterns. They may protrude quite prominently from the skin surface. The thick, bulky lesions can restrict movement if they form over joints. Keloids may be itchy or painful, especially when forming. The severe itchiness leads some patients to pick and scratch at lesions, causing further skin trauma.
Keloids pose a high risk of recurrence after treatment. They tend to regrow after being surgically removed. Recurrent keloids may be larger than the original. The high likelihood of recurrence makes treatment and management challenging.
How are keloids diagnosed?
Keloids are typically diagnosed based on clinical examination of the skin lesions. The provider will look for features that distinguish keloids from other raised skin growths:
– Location within a prior skin injury
– Growth beyond wound boundaries
– Persistence over time (months to years)
– Rubbery, nodular texture
– Shiny surface
– Reddish purple color
The patient’s history often reveals keloids developed after events like piercings, cuts, burns, acne, insect bites, surgery, or other skin trauma. There are no diagnostic tests for keloids. A skin biopsy may be done to confirm clinical suspicion and rule out skin cancer.
What are the treatment options for keloids?
A variety of treatment options are available for keloids, but none are highly effective on their own. The best results are seen with a combination approach tailored to the individual patient:
Steroid injections – Corticosteroid injections into the lesion reduce inflammation and collagen production. This helps flatten and soften keloids. Multiple injections are given over weeks or months.
Cryotherapy – Freezing keloids with liquid nitrogen causes localized injury that interrupts collagen synthesis and leads to lesion sloughing.
Silicone sheets/gel – Silicone sheets applied 12+ hours per day compress and flatten keloids. Silicone may also reduce collagen deposition.
Compression therapy – Elastic wraps or pressure earrings compress the tissue and limit blood supply to keloids. This reduces collagen formation.
Radiation – High dose radiation prevents excessive fibroblast proliferation and collagen deposition. It is often used adjunctively after surgery.
Laser treatment – Lasers cause controlled burns to the skin surface that induce collagen remodeling. This helps reduce scar thickness.
Surgical excision – Cutting out the keloid is often followed by other therapies (steroids, radiation) to prevent recurrence.
Interferon injections – Interferons inhibit collagen synthesis and may help improve keloids.
5-FU injections – The chemotherapy drug 5-fluorouracil blocks DNA and RNA production in fibroblast cells, curbing collagen formation and ideally shrinking keloids.
What is the best treatment approach?
Due to the high rate of recurrence, a combination approach is recommended for optimal keloid treatment:
1. Surgical excision – The bulk of the lesion is removed. Closure tension should be minimized.
2. Radiation – High-dose radiation is delivered soon after surgery to prevent regrowth.
3. Steroid injections – Multiple corticosteroid injections before and after surgery reduce inflammation.
4. Compression therapy – Earings, wraps, or silicone applied for 12+ hours per day.
5. Laser therapy – Laser sessions may further remodel collagen and flatten lesions.
This multipronged approach attacks keloids through several mechanisms. Combining modalities improves success rates compared to any single treatment. Even with combination therapy, keloids may still recur in some individuals. Maintenance steroid injections are often continued to hold recurrent keloids at bay.
How can keloids be prevented?
Since keloids form at sites of skin injury, prevention aims to limit trauma to susceptible skin:
– Avoid body piercing or tattoos through keloids-prone areas. Ear piercings carry high risk.
– Minimize cuts, burns, insect bites, or other skin injuries whenever possible. Clean and cover any wounds with adhesive bandages.
– Use sun protection including sunscreen, protective clothing, and hats to prevent sunburns.
– Treat acne with care, avoiding picking and popping which damages skin. Seek professional acne treatment if necessary.
– Have elective skin procedures (moles, cysts) removed with techniques that minimize skin trauma, such as lasers.
– After surgery in keloid-prone sites, follow up immediately with steroid injections or compression to prevent keloids.
– Genetic testing may someday identify those at highest risk for keloids, improving prevention.
While not always possible, avoiding skin trauma in the first place offers the best protection against development of new keloids. Prompt treatment of any wounds reduces the chances of excessive scarring.
Can diet impact keloids?
No specific diet has been proven to prevent or improve keloids. However, certain dietary measures may help reduce risk factors that could influence keloid severity:
A balanced, nutrient-rich diet supports wound healing and modulates inflammatory processes. Key nutrients involved in wound repair include protein, zinc, vitamin A, vitamin C, and iron.
Avoiding foods that worsen inflammation may help minimize redness, swelling, pain, and irritation of keloids. These foods include refined carbs, fried foods, processed meat, and excess alcohol.
Losing excess weight reduces inflammation linked to obesity. This may help improve treatment success in overweight keloid patients.
Quitting smoking is advised, as smoking impairs circulation and nutrient delivery to skin. This may hinder wound healing.
While research is limited, eating a wholesome anti-inflammatory diet dense in produce, lean proteins, nuts, seeds, and healthy fats appears prudent for supporting overall skin health and potentially reducing keloids risks. Patients should discuss any dietary changes with their managing provider.
Potentially anti-keloid nutrients
Vitamin E – Has antioxidant properties that may help reduce collagen accumulation. Found in nuts, seeds, vegetable oils.
Onions – Contain quercetin and other anti-inflammatory, collagen-reducing compounds.
Turmeric – Curcumin has anti-fibrotic effects in lab studies on keloids.
Green tea – Polyphenols called catechins may inhibit collagen synthesis.
Soy – Genistein found in soybeans may block pathways involved in extracellular matrix deposition.
Fish oil – Omega-3 fatty acids help resolve inflammation that exacerbates keloids.
Again, human studies are needed to prove true benefits from dietary components. But adding more natural anti-inflammatories may support conventional keloid treatment. Patients should start supplements only after consulting their physician.
Overview of keloid treatments
| Treatment | Pros | Cons |
|---|---|---|
| Steroid injections | -Reduce inflammation and collagen formation -Provide localized treatment -Effective for small keloids |
-Require multiple injection sessions -May cause skin atrophy or telangiectasia |
| Cryotherapy | -Induces sloughing of lesion -Relatively easy to perform |
-Recurrence risk still high -Lack of precision |
| Silicone products | -Compress and flatten keloids -Convenient for patients -Few side effects |
-Requires consistent long-term use -Limited efficacy as monotherapy |
| Compression therapy | -Limits blood supply to keloids -Can be combined with other treatments |
-Uncomfortable pressure required -Not useful for all keloid locations |
| Radiation | -Reduces recurrence when combined with surgery -Non-invasive |
-Expensive equipment required -Radiation side effects possible |
| Laser therapy | -Remodels collagen -Non-invasive approach |
-Multiple treatments needed -Less effective for severe keloids |
| Surgical excision | -Removes bulk of lesion -Opens wound for adjuvant therapies |
-High rate of recurrence -Risks of surgery |
| Interferon injections | -Inhibits collagen synthesis -Some clinical success |
-Injection site reactions common -Expensive |
| 5-FU injections | -Blocks DNA/RNA production -Shrinks collagen accumulation |
-Local pain/irritation -Low quality evidence so far |
Are home remedies effective for keloids?
A variety of home remedies and natural products have been anecdotally used to treat keloids, but there is limited clinical evidence regarding efficacy and safety. Discuss any home treatments with your provider first. Potential options include:
– Aloe vera – Has anti-inflammatory and wound healing properties. Apply gel from fresh leaves.
– Apple cider vinegar – Acetic acid may reduce lesion size and itch. Use diluted with water.
– Onion extract – Onions contain anti-inflammatory quercetin. Apply topically twice daily.
– Honey – Has antibacterial, wound healing benefits. Apply medical grade manuka honey.
– Lemon juice – Citric acid may exfoliate and flatten raised keloids. Apply diluted juice.
– Tea tree oil – Anecdotal benefits as antiseptic and anti-inflammatory. Use diluted in carrier oil.
– Cucumber slices – Cooling effect may temporarily relieve pain and itching.
– Turmeric paste – Curcumin offers anti-inflammatory effects. Mix with water into paste.
These remedies may provide mild symptom relief but likely offer minimal improvement to keloid size or recurrence risk when used alone. They do not replace medical treatment. Safety and proper use should be reviewed with a dermatologist.
When to see a doctor
You should consult a dermatologist or wound care specialist if you experience any of the following:
– Skin lesion growing larger than original injury site
– Persistent red or dark scar tissue that does not improve over time
– Scar tissue becoming raised, thickened, or rubbery
– Itchy, painful, or burning skin lesion
– Restricted movement due to tight scar tissue
– New skin lesion forming after injury that has potential to become a keloid – including piercings, cuts, burns, bites, surgery, tattoo, vaccination
– Existing keloid worsening or resisting at-home treatment
– Signs of infection including warmth, swelling, pus, red streaks, fever
Early clinical diagnosis and treatment provide the best chance of minimizing keloid size and progression. With appropriate treatment, keloids can be managed long-term to help reduce symptoms and cosmetic concerns.
Takeaways
– Keloids are overgrown scar tissues that exceed wound borders and do not regress. They often recur after treatment.
– Susceptible individuals should limit skin injuries from piercing, surgery, cuts, burns, and wounds when feasible.
– Combination therapy with surgery, radiation, steroid injections, and compression is most effective for reducing recurrence.
– Silicone, cryotherapy, lasers, and injectable medications may also improve keloids.
– Dietary anti-inflammatories like fish oil, vitamin E, and turmeric may provide modest adjunctive benefits but require further study.
– Seek professional medical treatment for problematic keloids or any new skin lesions with potential to scar excessively. Early intervention offers the best outcome.
