Keloids also known as keloid scars represent a big cosmetic problem. We can consider them as a type of impaired wound healing.


Scar formation is a natural part of wound healing. It is a complex and complicated system including tissue degradation and production of a new connective tissue. Keloids are caused by imbalance in this system with excessive formation of new tissue and its decreased disintegration. The problem is probably related to genetic predispositions. There is also higher risk of keloids formation in wounds located on the chest and on the back. Keloids more often occur in surgical wounds that are sewn too tightly and in infected wounds. Basically any disorder of wound healing, which prolongs the healing process, also increases risk of keloid scar.


Excessive connective tissue production leads to the growth of scar, which rises above the skin surface. The scar overgrows the wound edges and turns reddish. This is not only a cosmetic problem as the scar tissue may unpleasantly hurt or itch.


The diagnosis is usually made by physical examination as the keloid is clearly visible on first sight. When needed, a small sample of the tissue may be removed and sent to histological examination.


Prevention is very important. It is necessary to be careful with indications to skin surgical interventions, especially in people with already known tendency to keloid occurrence. Any wound must be carefully surgically treated to reduce risk of complicated healing. Despite all measures, however, keloid development is sometimes unavoidable.


Once formed collagen scar will never disappear completely and the goal of treatment is to diminish its size and thus the resulting cosmetic defect. It would seem logical just to surgically remove the keloid tissue but this creates a new wound that also heals by keloid tissue. Conservative approach is therefore preferred. We use some locally applied substances to reduce the formation of new tissue (such as corticosteroids) and the keloid may be reduced by some physical methods such by liquid nitrogen (cryosurgery).


In severe cases, we can resort to surgical removal of the keloid tissue and the procedure must be followed by the above-mentioned procedures to avoid any recurrence of keloid.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources