Keloids are thick, itchy, puckered clusters of scar tissue that grow beyond the edges of a wound or incision. Often they are red or darker in color than the surrounding skin. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed.
In the illustration, this thick, over-grown cluster of scar tissue on the earlobe is a keloid. It has been removed and the incision closed with stitches, leaving a thin scar.
Keloids can appear anywhere on the body, but the most common areas are over the breastbone, on the shoulders and on the earlobes. They occur more often in dark-skinned people than in fair-skinned people. The tendency to develop keloids lessens with age.
Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, these steroids will also shrink the scar.
If steroid treatment is inadequate, the scar tissue can be cut out and the wound closed with one or more layers of stitches. Generally, this is an outpatient procedure, performed under local anesthesia. You should be back at work in a day or two, and the stitches removed in a few days. A skin graft is occasionally used, although a keloid may develop at the site from which the graft was taken.
No matter what approach is taken, keloids have a stubborn tendency to recur, sometimes even larger than before. To discourage this, Dr. Lesavoy may combine the scar removal with steroid injections, direct application of steroids during surgery, or radiation therapy. Or you may be asked to wear a pressure garment over the area for as long as a year. Even so, the keloid may return, requiring repeated procedures every few years.