Keloid Scars: Oops, Too Much Healing!

The skin’s healing process is remarkable, but sometimes it goes awry, leading to keloid scars. These raised, often painful overgrowths extend beyond the original wound, turning a simple healing response into a persistent challenge. Whether from surgery, piercings, or minor injuries, keloid scars can affect both appearance and emotional well-being, making them more than just a cosmetic concern.

What is a keloid scar?

Keloid scars are abnormal tissue overgrowths caused by excessive collagen production during wound healing. Unlike regular scars, they continue growing beyond the original injury, forming raised, shiny, and often discoloured bumps.

Though rare in the Asian population (0–0.1%), keloid scars can range from small, flesh-coloured papules to large, dark growths. They may sometimes feel tender or painful, making them more than just a cosmetic concern.

Causes of keloid scars

Keloid scars result from an abnormal wound healing process where the body's inflammatory and regenerative responses go into overdrive. Instead of stopping once a wound heals, fibroblasts (cells responsible for producing collagen and repairing damaged tissue) continue producing excess collagen (a protein that helps form skin, tendons, and connective tissues), leading to uncontrolled scar growth. For a broader perspective on collagen, many wonder does collagen plump skin, as it plays a key role in maintaining skin elasticity, firmness, and hydration.

Genetics play a key role, with people of African, Asian, and Hispanic descent being more prone to keloids. Studies suggest variations in TGF-β signalling pathways (a biological process that controls how cells grow and heal) contribute to this susceptibility. Hormonal factors (chemical messengers in the body, like estrogen and testosterone) may also influence collagen overproduction (making too much collagen), making keloids more common during puberty and pregnancy.

Environmental triggers like piercings, burns, surgical incisions (cuts made during surgery), or chronic skin conditions can set off this excessive healing response. In susceptible individuals, ongoing inflammation (the body's reaction to injury, causing redness and swelling) and immune system overactivity (when the body's defence system works too aggressively) create a cycle of relentless scar tissue growth.

Keloid scar symptoms: How it shows up

Keloid scars have distinct features that set them apart from normal wound healing. They start as small, raised bumps and can grow beyond the original injury over time. Their surface is usually shiny, smooth, and firm to the touch.

Common symptoms include itching, tenderness, and pain, especially in the early stages. The colour of keloids varies based on skin tone, ranging from pink or red to dark brown or purple. As they enlarge, they become more noticeable, sometimes causing both physical discomfort and emotional distress.

Who is more likely to develop keloid scars?

Certain populations and personal factors increase the risk of keloid scars. Genetics play a major role, with individuals of African, Asian, and Hispanic descent being more prone to developing them.

Age is another factor, as keloids most commonly appear between 10 and 30 years. Hormonal changes during puberty and pregnancy can also trigger abnormal scar formation.

Certain medical conditions, such as Ehlers-Danlos syndrome and weakened immune systems, may further increase susceptibility. Additionally, a personal or family history of keloid scars is a strong predictor, highlighting their hereditary nature. To help strengthen your body’s defenses, you can follow simple tips to boost the immune system, including a balanced diet, regular exercise, adequate sleep, and stress management.

Keloid vs. hypertrophic scars: What’s the difference?

Scars form as part of the natural healing process after an injury, but not all scars look or behave the same. Two common types of raised scars are keloid and hypertrophic scars, which often get confused due to their similar appearance. Understanding the differences can help in managing them effectively.

Keloid scars:
Keloid scars are raised, thickened areas of skin that extend beyond the boundaries of the original wound. They can continue to grow over time and may become itchy, tender, or even painful. Keloids often have a shiny, smooth surface and feel firm to the touch. They are more common in people with darker skin tones and often appear on the chest, shoulders, earlobes, and upper back. Keloids tend to persist long-term and may require medical treatments such as steroid injections, laser therapy, or surgical removal to improve their appearance.

Hypertrophic scars:
Hypertrophic scars are also raised and thickened, but they remain confined to the area of the original wound. They usually develop within weeks of injury and may naturally improve over time. These scars can be red or pink, firm, and sometimes itchy, but unlike keloids, they do not grow beyond the injured area. Hypertrophic scars often respond well to treatments like pressure therapy, silicone sheets, or topical creams.

How do we prevent keloid scars?

Preventing keloid scars requires early and careful wound care. Minimising tissue disruption during healing can reduce the risk. Strategies include:

• Proper wound care: Keep wounds clean, moisturised, and protected.
• Collagen modulation: Silicone preparations and pressure therapy may help regulate collagen production.
• Dermatology consultation: Those with a high genetic risk should seek expert advice before elective procedures.
• Avoiding cosmetic piercings: If prone to keloids, it’s best to avoid unnecessary skin trauma.
• Managing skin conditions: Treat acne, infections, or other issues that may trigger excessive scarring.

Taking these steps can help prevent keloid scars before they form.

Your journey to healing continues

Keloid scars result from a complex mix of genetic, hormonal, and environmental factors, making them a unique challenge in wound healing. Though they can be frustrating, ongoing dermatological research offers hope for better prevention and treatment.

Understanding your risk factors, seeking early medical advice, and exploring innovative treatments can help manage keloid formation. A combination of medical interventions, lifestyle adjustments, and proactive skin care can make a significant difference. In the end, knowledge and personalised care remain the most powerful tools in managing this condition.

Frequently Asked Questions

1. What deficiency causes keloid scars?

Impaired wound healing due to a deficiency in zinc, vitamin C, or copper may predispose the development of scar tissue at abnormal sites, thus risking keloid formation.

2. How do you prevent a keloid from forming?

Keloid scarring, or rather keloid, can be dealt with by adopting medical care, lifestyle modifications, and a bold approach towards recovering the skin.

3. Is a keloid harmful?

Keloid scars are benign, but in the size and location of keloid scars, patients may often suffer from physical discomfort, psychological suffering, and functional limitations.

4. List of foods that would prevent keloid scars?

Some of the main food items, through which the wounds can be healed, are zinc-rich food, vitamin C, omega-3 fatty acids, and antioxidants.

5. Keloid scars stop growing at what age?

Keloid scars normally stabilise after age 30, though most growth occurs during puberty and early adulthood. Individual variations in scar progression may exist.