MEDICAL EDGE: Keloids tend to run in familiesMayo Clinic doctors answer questions
By: Marcus Frohm, M.D., Grand Forks Herald
Dear Mayo Clinic:
For the past 15 years I have developed keloids on my chest. I went for surgery once and have tried triamcinolone injections several times, but the condition was aggravated. Now if I have any pimples on my chest the ultimate result will be a keloid. What can be done? Will this continue my entire life?
Answer: Researchers don’t know why certain people get keloids. These thick, raised, bumpy areas on your skin — caused by an overgrowth of scar tissue where skin trauma has occurred — can be difficult to treat. The best approach in your situation is to try to avoid trauma that may result in a keloid and to protect your skin from keloid formation, when possible.
Although the underlying cause of keloids isn’t clear, research has shown that keloids tend to run in families. A person who develops even one keloid is at high risk of developing more. Keloids often form as a result of skin injuries caused by ear or body piercing, acne, tattoos, burns, scratches, surgical incisions, chickenpox, wounds and injections.
Keloids form most often on the ears, neck, shoulders, upper arms and chest. In some cases, keloids may itch or burn, but not everyone develops those symptoms. Keloids aren’t cancerous, and they don’t increase a person’s risk of skin cancer. Many people seek treatment for keloids for cosmetic reasons.
The first step for patients who are predisposed to keloids is to minimize skin injuries as much as possible. For example, avoid ear or body piercing and tattoos, as well as any unnecessary medical procedures that could cause a scar. Those who have acne or pimples should talk with a dermatologist about self-care and other measures to prevent pimples from developing.
Those prone to developing keloids who must undergo a procedure that may result in scarring should inform their doctor or surgeon about their condition. Using steroids around the edges of the wound during the procedure, or applying a medication on top of the wound after the procedure to reduce the skin’s response, along with special pressure dressings, may decrease the risk of keloid formation.
Once a keloid forms, effective treatment can be a challenge because, in some cases, treatment may make keloids worse. As in your case, most doctors treat keloids with steroid injections first. If that’s unsuccessful, surgical removal may be an option. Using a topical medication such as imiquimod — which can help alter the body’s immune response locally — during or after surgical removal may reduce the likelihood of another keloid forming in the same location.
Freezing a keloid with liquid nitrogen (cryosurgery) can be effective for removing small keloids. Laser treatment may also be helpful. Laser treatment, although it typically doesn’t completely eliminate a keloid, can make a keloid softer and flatter and reduce the skin discoloration that often accompanies keloids.
Unfortunately once you begin developing keloids, you remain at risk for additional keloid formation. That risk doesn’t decrease over time. Preventing the formation of new keloids in patients who are predisposed to forming keloids should be a primary goal. The treatment of keloids should be approached cautiously by a skilled provider to avoid making the problem worse. To manage your condition, work with a dermatologist, plastic surgeon, or other specialist who has experience treating people prone to developing keloids.