Keloider

Keloider are benign, excessive scar tissues that extend beyond the edges of a wound. They arise from abnormal wound healing and consist of dense, disorganized collagen and active fibroblasts. Unlike hypertrophic scars, keloider continue to grow beyond the original wound and do not typically regress.

Risk factors include darker skin types, family history, and prior keloids. They often occur after skin trauma such as surgery, ear piercing, burns, acne, or infections. Common sites are the earlobes, chest, shoulders, back, and upper arms.

Clinically they are raised, firm nodules or plaques, pink to skin-colored, sometimes itchy or tender. Size varies from millimeters to several centimeters. Diagnosis is usually clinical; biopsy may be performed to exclude other lesions and shows thick, whorled collagen bundles in the dermis with minimal inflammation.

Treatment aims to reduce symptoms and recurrence. First-line therapies include intralesional corticosteroids, silicone sheets, and pressure therapy. Other options are cryotherapy, various laser treatments, and, in selected cases, radiotherapy after excision. Surgical removal alone has high recurrence rates; combination therapy is often used. Prevention focuses on minimizing skin trauma and addressing high-risk wounds early.

Prognosis varies; keloider tend to recur after treatment and require long-term management. They are more challenging to control in darker-skinned individuals and in areas with high tension.