Keloids

What a keloid is

A keloid is a growth of extra scar tissue where the skin has healed after an injury [3]. It keeps going after the repair is finished, because the body lays down more collagen than the wound needed, so the scar ends up bigger than the cut that caused it [1].

Why this guide is written for Black patients

In the United States, keloids are more common in Black and Latin Americans than in people with lighter skin tones [1]. Published incidence in Black and Hispanic populations runs from roughly 4.5 percent to 16 percent, against under 1 percent in white and Taiwanese Chinese populations [4]. Risk is highest between the ages of 10 and 30, and in the United States it is Black people in that age band who carry the greatest risk [1][4].

It also runs in families. About one third of people who get keloids have a first degree relative, a parent, sibling or child, who gets them too [1].

Almost anything that scars can start one: a piercing, acne, a burn, a cut, a tattoo, a surgical wound [1]. The places they form most often are the earlobe, the neck, the breastbone, the upper back, the shoulders and the upper arms [4].

What to ask a clinician

• Is this a keloid or a hypertrophic scar, and how are you telling the difference?
• What is the plan if the first treatment does not hold?
• If you inject a steroid, what is the chance of a light spot in my skin tone?
• If surgery is part of the plan, what goes with it to stop the regrowth?
• What should I do before my next piercing, procedure or cut?

What good care looks like

Dermatologists often recommend more than one type of treatment rather than a single fix [2]. The reason is the recurrence rate. Between 50 and 80 percent of keloids shrink after being injected, but many of those regrow within five years [2]. Surgery on its own is worse: nearly 100 percent of keloids return after removal alone [2], and MedlinePlus warns that treatment, surgery above all, can leave the scar larger than it was [3]. So removal is normally paired with something else, such as steroid injections, pressure, silicone gel or sheets, cryosurgery, laser or radiation [2].

Raise one thing before you agree to injections. In darker skin, a corticosteroid injection can leave a light spot where the needle went in [2]. That is a known side effect, not a surprise, and it is worth discussing against the size of the keloid you are treating.

Sun matters in the first year. A new keloid will tan darker than the skin around it if it is exposed, so cover it with a patch or an adhesive bandage and use sunblock. Adults should keep that up for at least six months after the injury, and children for up to eighteen months [3].

When it is urgent

A keloid is not cancer, and it is not an emergency. See someone sooner if it sits over a shoulder or another joint, because a keloid there can limit how far you can move [2]. See someone sooner if it is painful, growing quickly, or bleeding, since a scar that behaves that way is a question for a dermatologist rather than something to keep watching.

What to do next

Book with a dermatologist, and go early rather than late. A small keloid has more treatment options than a large one, and the first conversation is worth having before the next piercing or planned surgery, not after. If you are choosing between clinicians, ask each one how many keloids they treat in skin like yours in a normal month.