Keloid FAQs

What is a keloid?

A keloid is a frustrating and sometimes debilitating way that some people scar. Our body forms scars to help heal and seal over a wound or injury. Normally, there is an inflammatory period of wound healing which transitions to a growth phase of scar tissue formation which soon after receives a signal to enter into a maturation phase in which scar tissue flattens and softens and fades. In individuals who may have genetic or other risk factors to form hypertrophic or keloid scars, there may be heightened or prolonged inflammation which leads to an overgrowth of scar tissue. This overgrowth of scar tissue may “miss” the signal to stop forming and start to remodel and mature. The abnormal scar tissue may stay within the borders of an injury or incision (hypertrophic scars), or continue to grow and begin to extend beyond the borders of the original injury or incision (keloid).

What causes keloids?

The exact cause of keloids is not fully understood, but it is thought to be related to a heightened and prolonged inflammatory state as well as the overproduction of collagen, the protein that makes up the connective tissue in our bodies. Keloids can develop in response to any type of injury or trauma to the skin, including cuts/scratches, surgical incisions, burns, tattoos, piercings, and acne.

Who is at risk for developing keloids?

Anyone can develop keloids, but some people are more prone to forming keloids than others, mainly due to their genetics. People with darker skin tones and those of African or Asian descent are more likely to develop keloids, as are people who have a family history of keloids.

How are keloids treated?

Keloids are very frustrating and can be difficult to treat, and there often is no “one size fits all” treatment. Some options include corticosteroid injections, laser therapy, radiation therapy and surgical removal. In many cases, a combination of treatments may be necessary.

Can keloids be prevented?

While there is no absolute way to prevent keloids, there are steps you can take to reduce the risk of a keloid forming. These include avoiding unnecessary skin trauma, keeping a wound site clean and protected while it heals, minimizing tension or stretch on a scar while healing, and avoiding piercing or tattooing.

Are keloids dangerous?

Keloids are benign, not contagious, and not dangerous in and of themselves, but they can be unsightly and may cause discomfort, pain or itching. In some cases, depending on their size and location, they may also restrict movement of joints, cause issues with ingrown hairs or skin infections, or interfere with normal bodily functions.

Can keloids come back after treatment?

Unfortunately, keloids do have a tendency to recur even after successful treatment. For this reason, it is important to continue monitoring the site of the treated keloid and seek treatment promptly if it begins to grow back. The recurrence rate of keloid scars can vary depending on the type of treatment used.

It's important to note that the recurrence rate of keloid scars can also be influenced by factors such as the location of the scar, the size of the scar, and the individual's tendency to develop keloids. A consultation customized to your particular scar can help you determine the best treatment options for your individual situation.

The good news is that we have the tools to offer patients customized treatment with the goal of maximizing aesthetic results while minimizing keloid recurrence as best as possible. Dr. Kenrick Spence uses tension free closure which is a key factor contributing to achieving the best aesthetic outcomes and promoting the reduction of reoccurrence of the keloid after the treatment.

What are some of the treatments available for keloids?

Here is an overview of some common treatment modalities for keloids:

1. Corticosteroid injections: Corticosteroid injections are a common first-line treatment for keloid scars. Steroids help to calm inflammation, soften scar tissue and make scars flatter, softer and less itchy.
2. Laser therapy: Laser therapy can be a useful way to improve the appearance of many scars and increase the effectiveness of keloid treatment. Like steroids, different types of lasers can soften scar tissue and make scars flatter, softer as well as improve their color and texture.
3. Radiation therapy: Radiation therapy is a targeted treatment to help prevent keloid recurrence following surgical removal. It can not only help to get rid of any remaining microscopic keloid cells after surgical excision, but it also “shocks” the body’s scarring mechanism to discourage it from entering a keloid-forming pathway.
4. Surgical removal: Surgical scar revision is a powerful way to change the shape and orientation of scars, with the goal to replace a wider, thicker scar with a thinner, flatter and finer scar. Surgical removal of keloid scars can be effective, but it also carries a higher risk of recurrence when done alone. The recurrence rate for keloids treated with surgical removal alone ranges from 70-90%. However, combining surgical removal with other treatments, such as radiation therapy or corticosteroid injections, can further reduce the risk of recurrence. When combined with steroid injections, recurrence rates range from 35-50%. When combined with radiation therapy, the recurrence rate for keloids can be as low as 5% to 10%.

What is SRT and how does it work?

Superficial radiation therapy (SRT) is a non-invasive treatment that has been shown to be effective in reducing the size and recurrence of keloid scars.

There are many different forms of radiation - including UV radiation from common sun exposure to medical-grade targeted radiation used to treat different conditions. SRT is unique in that it uses low-dose radiation to target the abnormal cells where keloids form. The radiation penetrates only the top layers of skin, making it a relatively safe and targeted treatment. SRT is typically given over a course of several sessions, each lasting only a few minutes. Most patients only feel some pressure from the SRT treatment arm on their surgical site.

Studies have shown that SRT can be highly effective in preventing the recurrence of keloids after surgery. In one study, the recurrence rate for keloids treated with SRT was close to 5%, compared to a recurrence rate of up to 50% for keloids treated with corticosteroid injections after surgery.

Is SRT safe?

SRT is very safe and well-tolerated by patients, with few side effects. Some patients may experience mild skin irritation or redness at the site of treatment, but this typically resolves within a few days.

Pigment changes, such as hyperpigmentation (darker spots) or hypopigmentation (lighter spots), are a possible side effect of radiation therapy as well as of steroid injections and laser treatments. However, the frequency of pigment changes after SRT for keloids can vary depending on various factors such as the radiation dose and the patient's skin type. Most patients see their pigment cells recover closer to normal over time.

It's important to note that SRT is not appropriate for all patients with keloid scars. During your consultation, we can help determine if SRT is a good option for you, based on factors such as the size and location of your keloid, your medical history, and your overall health.

What is excision and tension-free closure for keloids?

Excision is one powerful treatment option for keloids, in which the scar tissue is surgically removed. Excision needs to be precise, and the scar that we see on the surface is sometimes the “tip of the iceberg”, with pathologic keloid bundles extending deeper into the layers of the skin. Once all of the keloid pathology is excised, the wound is reconstructed and closed. However, if the wound is closed with tension, there is a risk that the new scar tissue will also become a keloid.

Tension-free closure is a technique that aims to minimize stress on the wound edges during closure, which can help reduce the risk of keloid formation. This can be achieved through techniques such as layered closure, widely undermining the surrounding skin, using tissue expanders to stretch the skin, or using a Z-plasty or other flap techniques to reposition the wound edges and redistribute the tension along the scar. By using various methods to minimize tension on the closure, the chances of a successful outcome from the surgery are increased.