Ep 172 – Keloid scars

Keloid scars are a form of abnormal scarring that occur in susceptible individuals and often appear to be more common in darker skin types. Often observed between the ages of 10 and 30 years, and associated with skin trauma or inflammation, their diagnosis is a clinical one. Unfortunately, no definitive treatment is currently available, but options include injectable preparations and cryotherapy, as well as surgery and radiotherapy. In this episode, Dr Roger Henderson looks at the aetiology, epidemiology and presentation of keloid scars as well as the efficacy of current treatments.

Key take-home points

• Keloid scars are a unique and complex dermatological phenomenon characterised by the overgrowth of dense fibrous tissue that extends beyond the original boundaries of a wound.
• Unlike normal scars that gradually fade and flatten over time, keloids tend to grow relentlessly, often becoming larger and more prominent than the initial injury site.
• The prevalence of keloid scarring varies widely among different populations and is heavily influenced by genetic predisposition and skin type.
• Although keloids can theoretically occur at any age they are most commonly seen in adolescents and young adults, coinciding with periods of heightened collagen production.
• Clinically, keloids present as firm, raised, shiny nodules or plaques that often extend beyond the margins of the original wound.
• High-tension areas such as the chest, upper back and shoulders are particularly prone to keloid development, as well as the earlobes.
• Common precipitating injuries include surgical incisions, ear piercings, lacerations, burns, acne lesions and even minor abrasions.
• Keloids unfortunately rarely resolve spontaneously and often persist indefinitely.
• The colour of keloids varies from pink to red to dark brown, frequently depending on the individual's skin type. There are no hair follicles or sweat glands within the scar.
• They are usually asymptomatic but may be associated with symptoms such as pruritus, pain, burning or tenderness. In some cases, they can cause functional impairment, particularly when they occur over joints or other areas of significant movement.
• If a skin biopsy is considered, this must be weighed against the risk of making the condition worse.
• The management of keloid scars is notably challenging, with high rates of recurrence even after treatment.
• In general, single, small keloid scars can be treated non-surgically, whereas large, bulky or multiple keloids should be assessed for surgery and adjuvant therapy.
• Beyond their physical manifestations, keloid scars can profoundly affect a patient’s quality of life. Disfigurement associated with large or prominently located keloids can lead to significant emotional distress, social isolation and even psychiatric disorders.

Related references and resources

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