DEAR DOCTOR K:
I have a keloid on my shoulder that makes me very self-conscious. Are there treatments other than surgery?
Keloids are raised overgrowths of scar tissue that usually appear at the site of a skin injury. They are harmless and do not become cancerous. But once a keloid develops, it won’t go away unless it is removed or treated. Unfortunately, none of the existing treatments give completely satisfying results. What’s more, keloids that have been removed or treated often return.
Keloids usually occur where trauma, surgery, blisters, vaccinations, acne or body piercing have injured the skin. Some people are prone to keloid formation and may develop them in several places.
Keloids appear most commonly on the shoulders, upper back and chest. They are shiny, smooth and rounded, and may be pink, purple or brown. Keloids can be doughy or firm and rubbery to the touch. They often feel itchy, tender or uncomfortable. (You can get a better idea of what a keloid looks like from the photo below. You can lear more about keloids and other skin conditions in our report Skin Care and Repair.)
Example of a keloid
You’ll have the best results if you start treatment soon after the keloid appears. Available treatments include:
- Conventional surgery. Keloids return in nearly half of patients when they are removed surgically — and these keloids may be larger than the original. Combine surgery with other treatments to reduce this possibility.
- Dressings. Moist wound coverings made of silicone gel sheets may reduce the size of keloids over time. This treatment is safe and painless.
- Corticosteroid injections. These can often reduce keloid size and irritation, but the injections are uncomfortable.
- Compression. A bandage or tape is used to apply continuous pressure 24 hours a day for six to 12 months. Compression can cause a keloid to shrink.
- Cryosurgery. This freezes the keloid with liquid nitrogen, but the treatment can cause skin color to lighten.
- Radiation therapy. This is controversial because radiation increases the risk of cancer. Radiation may reduce scar formation if it is used while a surgical wound is healing.
- Laser therapy. This is an alternative to conventional surgery. But keloids are just as likely to return after laser therapy as they are after regular surgery.
The two mysteries about keloids are: (1) Why do some people form keloids when their skin is cut, such as during surgery (I’m one of them), whereas other people do not; and (2) what stimulates the cells at the site of injury to grow in excessive numbers?
I’m optimistic there will be future diagnostic tests that can predict whether a person is likely to form a keloid after surgery. I’m also optimistic that we will figure out the chemical signals that encourage the overgrowth of skin cells — and figure out treatments that neutralize those signals and stop keloids from forming.