Keloids

ByDenise M. Aaron, MD, Dartmouth Geisel School of Medicine
Reviewed/Revised Sept 2023
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Keloids are smooth overgrowths of fibroblastic tissue that arise in an area of injury (eg, lacerations, surgical scars, truncal acne) or, occasionally, spontaneously.

Keloids are more frequent in darker-skinned patients. They tend to appear on the upper trunk, especially the upper back and mid chest, and on deltoid areas. Unlike hypertrophic scars, keloidal scar tissue extends beyond the margins of the wound or injury. They may appear spontaneously.

Various Manifestations of Keloids
Keloids on the Ear and Face
Keloids on the Ear and Face

    This photo shows keloids on the ear and beard area after dog-bite injuries.

© Springer Science+Business Media

Keloid
Keloid

    A keloid is hypertrophied tissue that develops in an area of injury or spontaneously; keloids are shiny, smooth, often dome-shaped, and slightly pink or hyperpigmented.

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Image provided by Thomas Habif, MD.

Keloid Scars
Keloid Scars

    In distinction from hypertrophic scars, keloids extend beyond the borders of the original wound invading normal skin. The patient has multiple large keloid scars on the anterior abdominal wall, after intra-abdominal surgery.

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© Springer Science+Business Media

Keloids are shiny, firm, smooth, usually ovoid but sometimes contracted or webbed, and slightly pink or hyperpigmented.

Diagnosis of Keloids

  • Clinical evaluation

Diagnosis of keloids is clinical.

Treatment of Keloids

  • Possibly corticosteroid injection, excision, gel sheeting, and/or immunomodulators

Treatment of keloids is often ineffective.

Surgical or laser excision may debulk lesions, but they usually recur larger than before. Excision is more successful if preceded and followed by a series of intralesional corticosteroid injections. Gel sheeting (applying a soft, semiocclusive dressing made of cross-linked polymethylsiloxane polymer, or silicone) or pressure garments are other adjuncts to prevent recurrence.

Drugs Mentioned In This Article
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