Keloid Scar

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Introduction

A keloid scar is a smooth, firm and raised lump of skin that can form anywhere the skin has been damaged. Damage to the skin can occur from cuts, burns, piercings, tattoo needles, surgery, acne or insect bites.

Keloid scars can:

Grow soon after skin damage, or months later.
Be of any size or shape.
Spread beyond the original area of skin injury.
Will not develop into a cancer
Limit movement of a joint if it grows on the skin above that joint

Hypertrophic scars are similar to keloid scars, but they don't grow beyond the area where the skin damage happened. They are less prominent. Hypertrophic scars often have a better response to treatment than keloid scars.

Two keloid scars on the shoulder of a teenager from acne scarring

Who gets it?

Any person can develop a keloid scar, but not all people do. People with darker coloured skin are more likely to develop keloid scars. There can be family history in children that develop keloid scars.

Children are more likely to develop a keloid scar if they:

Have had a keloid scar before
Have family members who have keloid scars
Have darker coloured skin
Have an injury to skin on the central chest, ears, chin or shoulders
Have underlying medical problems such as thyroid problems or high blood pressure.

What causes it?

When your child's skin is damaged, it repairs itself by forming a scar. Collagen is a normal protein within the skin that helps to form scars. When there is too much collagen within the healing scar, a keloid scar can develop.

The keloid scars in children commonly occur after peircing, acne and injury such as a burn or medical treatment.

What does it look and feel like?

Looks like…

Keloid scars will grow where skin has been damaged.
They will usually grow outside of the original area of skin damage, leading to a larger scar.
It can be of any size of shape.
It usually appears as a shiny, hairless, raised growth.
At first, they are pink, red or purple. Once they finish growing, they can darken.

Feels like…

Keloid scars usually feel smooth and rubbery.
Early on keloid scars feel soft while later they may become hard.
While keloid scars are growing, your child might find the middle of the scar painful and the edges of it itchy. Once keloid scars finish growing, they are usually not painful or itchy.

What tests might be needed?

Your doctor will be able to diagnose a keloid scar by looking at it, so it will not need any tests.

What treatments are available?

Treatment options are limited to those that flatten and reduce the scar your child already has. Unfortunately there are no treatments that make your child's scar disappear completely.

You should ask to see a dermatologist to discuss treatment options that are best for your child's scar.

What can I do?

If your child is more likely to develop keloid scars, you are best to prevent their skin from being damaged as much as possible.

Avoid having any unnecessary surgery for your child, if possible
Avoid having their skin pierced or tattooed
If your child has acne, see your dermatologist so they can help treat it early.

Medical therapies

Creams - steroid based creams may help improve itch
Silicon or gel dressings - these are helpful to reduce scarring risk after skin injury
Pressure dressings - are best in the early stages of scar formation
Steroid injections into the scar - the best treatment option in most situations
Laser therapy - helpful to improve the appearance and texture of the scar
Skin needling - softens very early scars but could potentially worsen scarring
Radiotherapy - not usually undertaken these days
Chemotherapy - usually undertaken with steroid injections
Surgical removal and postoperative radiotherapy: surgical removal on its own is not a good option, as it will often result in a new keloid scar that is larger than the original.

What happens after treatment?

Usually multiple treatments are required over a number of months to improve the appearance of the scar and stop further growth. If treatment does work for your child, the scar should look more flat, less prominent and be less itchy. Despite this, the scar footprint on your child's skin will likely remain indefinitely.

After treatment is stopped the scar may start to regrow. This may happen months to years after a course of treatment. Repeat treatment will usually be needed to stop it re-growing further.