Keloids: Early and proper intervention for the best outcome

Normally, an injury to the skin (wound) heals with a reasonable scar which becomes more flat and with less bothering symptoms such as pain and itching.

With some people however this may not be the case for the scar shortly or much later after healing, gradually starts to swell beyond the initial wound dimensions. Most times this is associated with a varying degree of pain and itching. These types of scars are called keloids and aren’t cancerous.

Keloids can form after any injury or procedure that breaks the skin. This can be after a cosmetic piercing (of the ears or another body part), a cut that gets infected or leaves a scar for example during shaving, acne (after the pimples heal) and sometimes surgery (forming in the surgical scar).

It’s also possible for keloids to form on uninjured skin. These keloids are called “spontaneous keloids.” They usually appear on the chest and usually develop in people who have a family history of developing keloids. When keloids develop spontaneously, it’s more likely that several more keloids will appear.

Keloids are basically as a result of an aggressive healing process of the wound. The exact cause isn’t well known but a number of factors have been found to increase one’s chances of developing these kinds of scars.

These keloids occur in about 5-15% of all wounds. They tend to affect both sexes equally, although a higher incidence exists of women presenting with keloids, possibly secondary to the cosmetic piercings.

The incidence of these scars is higher in people with darker skins (hence more common in people of African ancestry than Caucasians).  The average age at which people commonly develop these keloids is 10-30 years, with persons at the extremes of age (very young or very old) rarely being affected. Having a family history of keloids increases one’s risk of developing them, hence showing a genetic link in these keloids

Scars on certain body parts are more prone to becoming keloids. These include the middle chest, shoulders, ears, jaw, neck and upper back.

The diagnosis of a keloid is usually obvious by taking the patient’s history and looking at the scar. If the scar isn’t an obvious keloid, the doctor might take off a piece of tissue for further testing to confirm its nature.

There are many available treatment options for these scars, and one’s treatment options will depend on many factors such as; associated symptoms, patient’s age, location and size of the keloid, the available medical resources and expertise as well as the patient’s preference. Usually more than one treatment plan will be utilized to attain the best outcome

Some of these scars can be injected with a certain drug (usually steroid medicine) which can help to shrink the keloid as well as alleviate the associated bothersome symptoms of pain and itching.

This injection is then repeated usually every month for about 3-4 consecutive months or until the scar is flat and symptomless.

Normally, between 50% and 80% of the keloids shrink after being injected. Many of these keloids, however, will still regrow within 5 years following steroid injection.

Surgery to remove these keloids, especially large keloids can be done and needs close follow-up and subsequent steroid injections.

Other treatment options available for keloids include laser therapy, cryotherapy, radiation treatment, etc. Most of these are used in combination with another method for a good outcome.

It is important to understand that treatment for keloids isn’t a one day event, it requires patient as well as doctor commitment with close follow up, so that early intervention is done in case of any features of recurrence. This is because keloids can be more aggressive after attempted treatment without further follow ups.

Not a single week in our plastic consultations passes without meeting patients who have had previous attempted surgeries for keloids with little follow up done coming with very extensive keloids which are harder to treat than it would have been if the proper treatment and follow up plan was instituted initially.

People with family history of keloids should also avoid any form scars on their bodies whenever possible. These may include, but not limited to ear piercings and should have any inevitable scar closely followed up.

Dr Ian Shyaka , Resident in Plastic surgery, Rwanda Military Hospital,