DermatologyRehabilitation / Physical Therapy

Keloids: How to get rid of them

Scars come in several different ways- different colors, textures, and sizes. Over time, several scars grow smaller, smoother, and less noticeable.

But even mild injuries may cause scars that are disproportionately large, elevated, and dark in color in about 10 percent of people.

They extend well beyond the initial skin injury and can continue to develop over time. Keloids are classified as these types of scars.

Simple facts about keloids

  • Keloids may be a problem because of their appearance, particularly if they are on the face, neck, or hands.
  • The way to get rid of keloids is not foolproof.
  • In some individuals, particularly those with more pigment in their skin, a keloid forms as a result of an exaggerated healing response.
  • Keloids may be able to enhance the appearance of prescription drugs and in-office procedures.

Why are keloids a problem?

keloids
Keloids, unlike other scars, do not regress over time.

People with keloids, though unsightly, may have problems that go beyond esthetics. Keloids, if they occur near a joint, such as the knee or ankle, may cause pain, tightness, or even restricted range of motion.

Excessive skin stretching can cause itching, and keloids are susceptible to rubbing on clothing because of their larger size, causing discomfort.

Like any scar, keloids can be tricky to treat. However, medical advancements in keloid treatment are being made that could hold promise.

For people who are susceptible to having keloids, preventing keloids by proper wound treatment and avoiding skin damage, such as piercings, is the best approach.

Causes

A keloid develops due to the skin’s exaggerated response to an injury. Keloids can cause even small cuts. Some of the most common keloid triggers include:

  • cuts or punctures, including from shaving
  • burns
  • incisions from surgery
  • insect bites
  • skin conditions, such as acne
  • chickenpox or diseases that cause scarring of the skin
  • tattoos or piercings

Without any apparent cause, some keloids form. An analysis in the Journal of Medical Investigations and Practice states that without the existence of a skin injury, certain keloids have been known to appear. They can also pop up years after an accident has occurred.

It sends collagen-making cells to repair the wound when the skin is injured. The cells hopefully do their job and close the wound, leaving a tiny scar. For keloids, even after the wound is healed, the skin’s cells begin to multiply. The scar tissue, forming a big, raised scar, continues to develop.

Although keloids can occur in any type of skin, they are more likely to develop in:

  • Those with a history of Keloids in the family
  • People under 30, particularly adolescents who are going through puberty,
  • People who are pregnant
  • individuals with darker skin tones, such as those people of Asian, Hispanic, or African-American descent, are also more prone to developing keloids than other people

Keloids are known to be a type of tumor that is benign. They do not turn into cancer or raise serious health issues, even though they can be bothersome.

Keloids and piercings

Use of non-metal earing backs
The use of non-metal earing backs can help avoid the formation of keloids after ear piercing.

Keloids are also formed after piercings. In comparison to other skin injuries, it is unclear if they occur more often after piercings. They are more common than on other parts of the body on the earlobes, but this is possibly because piercings are a popular place for the earlobes.

While it is not always possible to avoid keloids, there could be a few ways to decrease the chance of having one after a piercing:

Use non-metal earring backs

A research in the Australasian Journal of Dermatology investigated the explanation why, after an ear piercing, keloids appeared to develop more often on the back of the earlobe. They determined that on the back of the earlobe, earrings with metal backs more frequently contributed to keloids.

As such, they say that the use of non-metal earring backs may be a way to minimize the risk after a piercing of having a keloid on the back of the earlobe.

Piercings and age

In children who had their ears pierced after 11 years of age, a study in AAP News & Journals found that keloids from ear piercings were more common. The occurrence of keloids was much lower in children under the age of 11 years after ear piercings.

If there is a family history of keloids, the writers recommended having the piercing before 11 years of age, or preventing ear piercing.

Keloids are notoriously hard to remove once you have them and have a very high risk of re-growing once they are surgically cut out. This is because the body is likely to react to this surgery in the same exaggerated way as it did to the initial injury.

Home remedies

There have been no home remedies shown to get rid of keloids once they have formed. Although, after a skin injury, there are a few things that people can do at home to either avoid the development of keloids or diminish their appearance.

Silicone sheeting or gel

Silicone is one of the most frequently used scar treatments, and some raised and keloid scars have been shown to help shrink. Silicone is readily used and has a low chance of adverse effects.

Reviews published in Cosmetic Plastic Surgery and the Journal of Cutaneous and Aesthetic Surgery confirm that the use of silicone sheeting or gel as suggested will provide an efficient way to minimize or avoid the development of existing raised scars.

A heavy cream or lotion on the skin

A review in the International Journal of Cosmetic Science notes that some skin products can enhance the appearance of a scar, such as those containing lanolin or petrolatum. As the wound is healing, people can use the creams on a daily basis to cover the scar.

While creams containing onion extract or vitamin E are commonly used for scars, these ingredients have not been shown to help with keloids, an analysis in American Family Physician and a study in Dermatologic Surgery found.

Medical treatments

Options include:

Tretinoin cream (Retin-A)

Temporarily freezing tissues with cryotherapy
Temporarily freezing tissues with cryotherapy may help to reduce the appearance of keloids.

Tretinoin is a prescription medication that people apply to their skin. Commonly used for acne and aging, it works by accelerating the normal cell turnover of the skin.

A 2010 review in the Journal of Clinical and Aesthetic Dermatology found that retinoids may help decrease the size and appearance of keloids, such as tretinoin cream and isotretinoin.

Cryotherapy

Cryotherapy is a procedure that involves freezing the tissues with a handheld device temporarily. The therapy is well accepted by most people, but during the treatment that goes away afterwards, some people may feel extreme pain.

A small study published in the Journal of Cutaneous and Aesthetic Surgery indicates that cryotherapy can minimize keloid size by up to 50 percent after several treatments. However, the report also notes that on smaller keloids that are less than 3 years old, cryotherapy works best.

Steroid injections

For years, this therapy has been used with some success on keloids. Injected steroids are an efficient way to decrease the size and presence of keloids, a report in the Journal of Medical Investigations and Practice said.

In American Family Physician, a study notes that steroid treatment works better on younger keloids and to remove part of the scar when combined with surgery. It can be used in combination with cryotherapy as well.

Imiquimod cream

A variety of skin tumors, including superficial basal cell skin cancers, are treated with this cream. After a keloid is extracted, it continues to act well on the skin. The cream decreased the chances of a keloid coming back, a study in the Journal of Oral and Maxillofacial Surgery found.

Radiation treatment

A brief course of radiation therapy, which is offered directly after surgically cutting out the keloids, requires a newer procedure that shows promising results. Several research in the literature on plastic surgery and dermatology indicate a high rate of cure, or at least improvement, of keloid scars in individuals treated with this technique.

Conclusion

Since keloids are hard to treat, it is best to take action soon after an injury, surgery, or piercing to avoid them. People who are susceptible to keloids may wish to fully avoid tattoos and piercings. If, for whatever reason, anyone needs surgery, they should make their doctor aware of any keloid history so that prevention will begin shortly after the surgery.

They can be emotionally and mentally harmful, but keloids do not pose a health danger. There are some available therapies, but no one treatment works for all. People will need to consult with their doctor about options for keloid removal and decide the best course of action to take.

Sources

  • Barara, M., Mendiratta, V., & Chander, R. (2012). Cryotherapy in treatment of keloids: Evaluation of factors affecting treatment outcome. Journal of Cutaneous and Aesthetic Surgery5(3), 185–189 (LINK)
  • Chung, V. Q., Kelley, L., Marra, D., & Jiang, S. B. (2006, February). Onion extract gel versus petrolatum emollient on new surgical scars: Prospective double-blinded study. Dermatologic Surgery32, 193–197
    (LINK)
  • Hochman, B., Isoldi, F. C., Silveira, T. S., Borba, G. C., & Ferreira, L. M. (2015, February 25). Does ear keloid formation depend on the type of earrings or piercing jewellery? Australasian Journal of Dermatology56(3), e77–e79
    (LINK)
  • Juckett, G., & Hartman-Adams, H. (2008, August 1). Management of keloids and hypertrophic scars. American Family Physician80(3), 253–260
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  • Keloids and hypertrophic scars. (n.d.)
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  • Keloids: Overview. (n.d.)
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  • Keloids: Prevention and treatment. (2009, August 1). American Family Physician80(3)
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  • Lane, J. E., Waller, J. L., & Davis, L. S. (2005, May). Relationship between age of ear piercing and keloid formation. Pediatrics115(5), 1312–1314
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  • Mustoe, T. A. (2008, January). Evolution of silicone therapy and mechanism of action in scar management [Abstract]. Aesthetic Plastic Surgery, 32-82
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  • Mustoe, T.A., Cooter, R., Gold, M. H, Hobbs, F. D., Ramelet, A. A., Shakespeare, P. G., … Ziegler, U. E. (2002, August). International clinical recommendations on scar management [Abstract]. Plastic and Reconstructive Surgery110(2), 560–71
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  • Onyenyirionwu, E & Agu, A. (2015, November 4). Keloids: A review. Journal of Medical Investigations and Practice10(1), 24–29
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  • Perkins, K., Davey, R. B., & Wallis, K. A. (1983, January). Silicone gel: a new treatment for burn scars and contractures. Burns9(3), 201–204
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  • Proper wound care: How to minimize a scar. (n.d.)
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  • Puri, N., & Talwar, A. (2009, July–December). The efficacy of silicone gel for the treatment of hypertrophic scars and keloids. Journal of Cutaneous and Aesthetic Surgery2(2), 104–106
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  • Rawlings, A. V., Bielfeldt, S., & Lombard, K. J. (2012, September 21). A review of the effects of moisturizers on the appearance of scars and striae. International Journal of Cosmetic Science34(6), 519–524
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  • Shin, J. Y., Yun, S.-K., Roh, S.-G., Lee, N.-H., & Yang, K.-M. (2017, February). Efficacy of 2 representative topical agents to prevent keloid recurrence after surgical excision. Journal of Oral and Maxillofacial Surgery75(2), e1–401–e6
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  • Viera, M. H., Amini, S., Valins, W., & Berman, B. (2010, May). Innovative therapies in the treatment of keloids and hypertrophic scars. The Journal of Clinical and Aesthetic Dermatology3(5), 20–26
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  • Medicalnewstoday – How do you get rid of keloids? (LINK)

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