Keloids

Keloids are benign overgrowths of scar tissue that form at the site of skin injury and extend beyond the wound boundaries. They result from excessive fibroblast activity and collagen production. Unlike hypertrophic scars, keloids do not regress spontaneously and are more common in individuals with darker skin tones, often appearing in young adulthood.

Common sites include the earlobes, chest, shoulders, and upper back. They are often firm, shiny, and range from pink to dark brown. They may be itchy or painful, and triggers include surgery, piercings, burns, acne, and minor injuries.

Diagnosis is usually clinical, based on appearance and history. Biopsy is rarely needed but may distinguish keloids from other scar disorders. Histology shows thick, disorganized collagen fibers with increased dermal vascularity.

Treatment is aimed at reducing size and symptoms, but no therapy reliably cures keloids and recurrence is common. Options include intralesional corticosteroids, silicone gel sheets, and pressure therapy; laser therapy; cryotherapy for small lesions; and, when excised, adjuvant therapy (steroids or radiotherapy) to lower recurrence. Surgical excision alone is discouraged.

Prognosis is variable; keloids persist and may recur after treatment. Prevention focuses on minimizing skin injury and inflammation, careful wound care, and avoiding unnecessary procedures in high-risk individuals.