They can extend beyond the limits of the skin damage that caused the scar to come up in the first place. They are shiny and hairless; usually they feel firm and rubbery. New keloids are often red or purple and become browner and sometimes paler with time. Most people with keloids have only one or two. However some people have many, especially if they have come up following acne or chickenpox scars. A tendency to get keloids certainly runs in some families.
It is not uncommon for surgical or injury scars to become a little lumpy (hypertrophic).
A keloid differs from these in several ways:
- A keloid can come up after very minor skin damage, such as an acne spot, or even if there has been no obvious damage to the skin at all.
- It can spread outside the original area of skin damage.
- It may last for many years.
With keloids, prevention is better than cure. You face extra risk of getting a keloid if:
- You have had a keloid before.
- Members of your family have had them.
- You have a dark skin.
If you are at risk, you should avoid tattoos or body piercing particularly if these would go through one of the high-risk areas of skin, such as the ear lobes. If you have acne, see your doctor to make sure it is treated vigorously to limit the risk of scarring. You should also avoid having skin surgery for cosmetic purposes.
Usually the main problems caused by keloid scarring are cosmetic, but some may be tender, painful, itchy, or cause a burning sensation. If they are very tight, they can limit movement at nearby joints.
Your doctor will be able to make the diagnosis of a keloid just by looking at your skin.
Treatment of keloid scars is not always successful, in fact it is unusual for a keloid to be completely cured after treatment. The main problem is that cutting a keloid out often leads to an even bigger one forming later in the same place.
Possible treatments include:
- Injections of a steroid (triamcinolone) into a keloid may help to flatten small early ones.
- Steroid-impregnated tape applied for 12 hours a day may help to flatten keloids.
- Freezing with liquid nitrogen may also stop early keloids from growing.
- Putting a silicone sheet over them at night for several months helps some keloids to flatten. Long-term compression with pressure bandages sometimes helps too.
- Laser treatment makes keloids less red, but does not make them smaller.
- If a keloid is cut out, it usually comes back, and may end up larger than it was before. This risk falls if the area is treated after the operation with pressure dressings or local steroid injections.