3.2.4 Keloid

Grading & Level of Importance: C




Cheloid, Cicatrix keloidalis.


Higher incidence in dark-pigmented populations, during puberty and pregnancy and in positive family history.


Benign scar tissue which grows beyond the borders of the original injury or surgical defect.

Aetiology & Pathogenesis

Aberrant wound healing of surgical wounds, injuries (piercings, tattooing, scarification, insect bites, vaccinations), burns, skin-damaging infections, acne, increased skin tension, spontaneous (no trigger found). Overproduction of collagen I and III (20x greater than that of healthy skin and 3x greater than a hypertrophic scar).

Signs & Symptoms

Bizarre sharply bordered nodular proliferation of connective tissue with erythema, pruritus and sometimes pain. Keloid extends beyond original defect.


Predilection sites: presternal, neck, shoulders, tense wounds, joints.


No international classification exists, clinically: suppurative keloid, presternal keloid, juxta-articular keloid, folliculitis keloidalis nuchae.


Increased whorls of thickened, hyalinized collagen bundles of the dermis.


Keloids may develop 1 to 12 months after injury. Do not improve with time or heal spontaneously.


Contractures over joints hamper motion, chronic itching/pain.


History, clinical features.

Differential diagnosis

Hypertrophic scar (remains confined to area of surgery or damage), sarcoidosis, dermatofibroma, dermatofibrosarcoma.

Prevention & Therapy

Prevention is essential, cosmetic and elective surgical procedures should be performed considering the development of keloids. Rapid primary closure, adequate hemostasis, reduction of wound tension, compression therapy may reduce keloid development.

Intralesional corticosteroids mostly in combination with contact cryosurgery, intralesional cryosurgery, surgical excision with post-surgical radiation or intralesional steroids, radiotherapy, LASER treatment can be considered.  Topical imiquimod, intralesional botulinum toxin, intralesional bleomycin or 5-fluorouracil, silicone gel tapes.

It is important to manage patient expectations.

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