Unlike typical scars, keloids extend beyond the boundaries of the original wound and can be raised, thickened, and discolored. They are an abnormal form of scar tissue that can occur following skin injury or trauma. This article explores keloid scar causes, symptoms, diagnosis, treatment, and prevention.
Causes
It occurs when the body overproduces collagen during the healing process, resulting in excessive scar tissue formation.
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An injury to the skin can cause keloids, such as surgical incisions, burns, cuts, abrasions, piercings, vaccinations, or acne scars.
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Individuals with a family history of keloids are more likely to develop them themselves, suggesting a genetic predisposition.
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Due to differences in collagen production and skin healing processes, people with darker skin tones are more likely to develop keloid scars.
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During puberty, pregnancy, or menopause, hormonal fluctuations can affect collagen synthesis and increase the risk of keloid development.
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Certain inflammatory skin conditions, such as acne, eczema, and psoriasis, may predispose individuals to keloid formation.
Symptoms
The following symptoms may be associated with keloid scars:
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A keloid usually appears raised and elevated and may extend beyond the boundaries of the original wound or injury.
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Keloids contain excessive collagen and fibrous tissue, causing them to thicken and become firmer than surrounding skin.
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There is a possibility of keloid scars appearing darker or lighter in color than the surrounding skin, depending on factors such as melanin production, inflammation, or vascularization.
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When keloids are located in areas prone to friction or movement, they may cause itching, tenderness, or discomfort.
Diagnosis
The diagnosis of keloid scars is usually determined by clinical evaluation and visual inspection. Diagnostic procedures may include:
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A healthcare provider will ask about the onset, duration, and progression of the scar, as well as any history of skin trauma, surgery, or inflammatory conditions.
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An examination of the scar and surrounding skin can help determine the size, shape, texture, color, and location of the keloid scar and distinguish it from other types of scars and skin lesions.
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In some cases, a skin biopsy may be performed to confirm the diagnosis of a keloid and rule out other skin conditions or tumors. A biopsy involves the collection of a small piece of tissue from the scar for examination under a microscope.
Treatment
Treatment options for keloid scars include reducing symptoms, improving cosmesis, and preventing recurrence.
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Intralesional injections of corticosteroids, such as triamcinolone acetonide, can help flatten and soften keloid scars by reducing inflammation, collagen synthesis, and scar tissue formation.
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When keloid scars are smaller or localized, surgical excision may be considered, particularly if they cause functional impairment or cosmetic concerns. Surgery alone, however, carries recurrence risk, and it may be combined with other treatments like corticosteroid injections or radiation therapy.
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For smaller keloids or as an adjuvant therapy following surgical excision, cryotherapy involves freezing the scar with liquid nitrogen or other cryogenic agents.
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In addition to hydrating the skin, improving collagen alignment, and providing occlusive protection from external irritation, silicone-based products can help flatten and soften keloid scars.
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By targeting blood vessels and stimulating collagen remodeling in the dermis, laser therapy can reduce redness, vascularity, and thickness of keloid scars.
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After surgical excision of keloid scars, radiation therapy may be used to reduce the risk of recurrence by inhibiting collagen synthesis and fibroblast proliferation.
Prevention
Keloid prevention involves minimizing skin trauma, avoiding risk factors, and intervening early in high-risk individuals. Prevention strategies may include:
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To minimize tissue trauma, promote wound healing, and prevent keloid formation, practice gentle wound care techniques following skin injuries or surgical procedures.
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Those with keloid scars or other risk factors should avoid unnecessary skin trauma or procedures, such as piercings, tattoos, or elective surgeries.
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In order to promote flat scar formation and reduce the risk of keloid formation, apply pressure dressings, silicone gel or sheeting, or topical treatments to newly healed wounds or surgical incisions.
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Seek medical attention promptly if you notice abnormal scar formation or excessive scarring, and discuss preventive measures or treatment options with your healthcare provider.
