Keloid: symptoms, causes and treatment

When your skin is damaged by a wound, cut, surgery, or skin disease, your body engages a miraculous repair mechanism. It creates new skin cells and produces connective tissue to repair the damaged area. This process occurs not only in the epidermis, but also in the deeper layers of the skin. The result is a scar, a visible sign of the healing process.

For most people, this healing process goes without a hitch. The scar is formed, stays within the boundaries of the original wound, and often fades with time. For some people, however, this process is different. The scar tissue continues to grow even after the wound has healed a long time ago. It grows beyond the original wound boundaries and forms a thick, raised strand or lump on the skin. This is what we call keloid, or popularly wild meat.

The important difference with a normal scar is that keloid does not shrink by itself. While normal scars often gradually fade and become flatter, a keloid persists and can even grow over months and years. This also makes keloid different from hypertrophic scars, another form of excessive scar growth. Hypertrophic scars remain within the original wound limits and often improve spontaneously within six to 12 months.

The exact cause of keloid formation is not yet fully understood. It has to do with a disturbed balance in the scar healing process, where too much connective tissue is produced. Keloids are more common in certain groups of people. Young people under thirty are at increased risk, as are dark-skinned people. Heredity also plays an important role: if keloid occurs in your family, you are more likely to develop it too. In addition, there are conditions that can promote keloid formation, such as wound infections and wound tension during healing.

The onset of keloid usually begins three to four weeks after a skin injury. During this period, the wound appears to be healing normally, but then the scar tissue suddenly begins to proliferate. This can include various forms of skin damage: a surgical wound, a cut, a burn, acne scars, an earring prick or even an insect bite.

During the normal healing process, special cells called fibroblasts make new connective tissue to close the wound. During keloid formation, these cells become overactive and keep producing collagen, the protein that gives connective tissue its strength. It is as if the stopping moment is missed and the production process continues to accelerate. The overproduction of collagen leads to a buildup of scar tissue that not only grows upward but also expands sideways beyond the boundaries of the original wound. This growth can last for months to years.

Wound infection significantly increases the risk of keloid. If a wound becomes infected, the healing process takes longer and there is more inflammatory activity. This prolonged inflammatory response can interfere with the healing process and lead to excessive scarring. Tension on a wound also plays a role: if a wound is in a place where there is a lot of skin movement, or if the skin is stretched during healing, the risk of keloid increases.

An important characteristic of keloid is that it has a tendency to recur. If you've ever had a keloid, chances are you'll develop a keloid again in the event of a new injury. This is especially true for the same parts of the body. That's why prevention is so important in people who are prone to keloid formation.

Recognizing keloid is usually not difficult because of its distinctive appearance. In the initial stages, a few weeks after the wound, the scar begins to change. It thickens and begins to harden. As the keloid grows, the elevation increases and the scar can develop a hard, rubbery texture.

The color also changes. Fresh keloids are often red or pink, while older keloids may turn brown or even darker than the surrounding skin. This discoloration is often more pronounced in dark-skinned people. The shape of keloids can vary: some are narrow and form a raised strand along the line of the original wound, others widen and form a knobby, irregular mass. The size can vary considerably, from small elevations to large keloids that are several centimetres in diameter.

In terms of sensation, keloid is usually not painful, but it can be quite itchy. This itch can be persistent and very annoying, especially in the growth phase. However, scratching does not make it better and can even cause scar damage. In the case of keloids in areas where the skin needs to be able to move, such as around joints, they can restrict freedom of movement. A keloid over a knee or elbow can prevent the joint from flexing.

The most burdensome aspect of keloid is often its cosmetic impact. Especially keloids in visible areas such as the face, neck or chest can cause a lot of uncertainty. The raised, discolored mass attracts attention and can affect someone's self-confidence. In young people, who develop keloid more often, this can be extra difficult.

Keloid has clear preferred locations on the body. The most common place is the ears, where piercings for earrings are a frequent cause of keloid formation. Even with a trouble-free piercing, a keloid can later develop around the hole, sometimes quite the size of a lump on the earlobe.

The chest is another common location. In people with acne, the inflammations can lead to scars that grow into keloids. Surgical wounds on the chest, for example after cardiac surgery, can also form keloids. The shoulders are also sensitive areas where vaccinations, tattoos or other skin lesions can lead to keloid formation. The same goes for the chin and neck, where men sometimes develop keloids after shaving injuries or inflamed hair follicles. The legs can also be affected, although this is somewhat less common.

It is remarkable that keloids rarely occur on the face, palms or soles. These areas appear to be less susceptible to this form of excessive scar growth. Areas where the skin is under tension, where there is a lot of movement, or where the wound is stretched while healing are more sensitive. This explains why shoulders, chest and chin are affected relatively often.

The diagnosis of keloid is usually easily made by your doctor based on its appearance and location. The characteristic aspect of growth outside the wound limits, combined with the typical locations and the elevated character, make keloid easily recognisable. Your doctor will also pay attention to possible complaints such as itching or restricted movement, and, of course, to the cosmetic impact.

Treatment of keloid is not easy. It is important to realize that treatment is only considered if the keloid is really bothering or for aesthetic reasons. A keloid that causes no symptoms and is in an invisible place does not necessarily need to be treated. The choice of treatment is personal and depends on how burdensome you find the keloid to be.

The most common treatment is injecting anti-inflammatory medication directly into the scar. This treatment inhibits the inflammatory response and collagen production. The treatment usually has to be repeated several times at intervals of several weeks. The effect varies: in some people, the keloid becomes significantly smaller and flatter, while for others, the result is disappointing. Patience is important, as it can take months to see the effect.

For severe or persistent keloids, radiation or laser therapy may be considered. Irradiation is sometimes used shortly after a surgical removal of the keloid to prevent recurrence. Laser therapy can help improve the color of the keloid and soften its texture, although the effect varies.

Surgical removal may seem like the most obvious solution, but paradoxically, it is often problematic. After all, cutting away a keloid creates a new wound, and for people who are sensitive to keloid formation, this new wound can grow into a new keloid, sometimes even larger than the original. Therefore, surgery is usually only considered in combination with other treatments, such as applying radiation immediately after surgery or injecting anti-inflammatory medications.

There is much confusion and misinformation about the treatment of keloid. It's helpful to know what isn't working so you have realistic expectations and don't waste your money on useless products.

There are countless creams, ointments and oils on the market that claim to reduce or prevent keloids. Almost none of these products have scientific proof that they work. They may have mild moisturizing or soothing properties, but they do not significantly reduce keloids. So be critical of marketing claims and ask your doctor for advice before purchasing expensive products.

The idea that keloids disappear by themselves if you wait long enough is also wrong. Unlike normal scars that fade over time, keloids persist and can even grow further. Waiting without treatment is therefore not an effective strategy if you have a keloid. Massaging a keloid with the idea that it softens and reduces scar tissue has no proven effect. The firm, excessive collagen structure is not easily influenced by massage.

Trying to remove a keloid yourself at home by cutting it off, tying it or treating it with home remedies is not only ineffective but also dangerous. You risk infections, pain and often the keloid will come back even bigger afterwards. The use of vitamin E oil, a common advice, also has no proven effect on keloids. The same goes for aloe vera gel and other natural remedies that are often touted.

Finally, don't expect miracles from a single treatment. Treating keloid requires time, patience and often a combination of different methods. Even after successful treatment, the risk of recurrence is present.

Can I prevent keloid?

If you know you're susceptible to keloid formation, prevention is the best strategy. Avoid unnecessary skin damage such as piercings and tattoos. In case of injuries, good wound care is essential: keep the wound clean, prevent infections and ensure that there is as little tension as possible on the wound while healing. During surgery, you can discuss with your surgeon that you are sensitive to keloid so that extra precautions can be taken.

Is keloid hereditary?

Yes, there is clearly an inherited component. Keloid is more common in some families. If your parents or siblings have had keloids, your risk is increased. This also means that if you develop keloids, your children may be at increased risk.

Can keloids become malignant?

No, keloids are benign. They can't degenerate into cancer. They are not malignant neoplasms but an overreaction of the normal healing process. Although they can be annoying, they are not a health hazard. The main reason for treating them is cosmetic or because of complaints such as itching or restricted movement.

How long does it take for treatment to work?

This varies greatly by treatment method and by person. When injecting anti-inflammatory medication, you can see improvement after just a few treatments, but the full effect can last for months. It is important not to give up too early and to maintain treatment consistently.

What if I need surgery and am sensitive to keloid?

Always discuss this with your surgeon beforehand. There are measures that can reduce the risk, such as extra careful stitching techniques, ensuring that there is minimal tension on the wound, and sometimes preventive treatment with anti-inflammatory medication or radiation immediately after surgery. It is also important to take extra good care of the wound during the healing process and to have it checked regularly.

Can I still exercise with keloid?

Yes, keloid doesn't have to hamper you in your daily activities or sports. However, it is wise to protect keloids against friction caused by clothing. Wear comfortable clothing that doesn't chafe and consider covering the keloid during intense activities. Also, make sure you don't get any new injuries during exercise, as any new wound can lead to a keloid if you are sensitive to it.

1. Skindr dermatologists
2. Health and Science: Abnormal scar tissue (wild meat, keloid)
3. eBPNet (Evidence-Based Practice Network)
4. Huidziekten.nl