Why do I have a keloid scar?

When skin is injured, the body's natural way to protect and repair itself is to produce scar tissue - a collection of cells and collagen that covers the injury site. Sometimes, in roughly 10% of people, something doesn’t work as it should and extra scar tissue grows to form smooth, hard growths often much larger than the original wound.

We sat down with Dr Mohammed Shareef, a Yorkshire-based consultant dermatologist and expert in treating keloid scars, to ask him why these fibrous growths form and what kind of treatment is currently out there for people who develop them.

What is a keloid scar and what causes it?

A keloid scar is a type of raised scar. It can appear as a firm and fibrous overgrown area of the skin, beyond the initial wound or injury, and is sometimes painful and itchy.

During the process of wound healing, collagen fibres are laid down in a criss-cross fashion to increase the strength of the wound and promote healing. Normally, a signal is sent by the body’s regulatory system to stop the production of this collagen, however, if the signal doesn't come, the wound doesn’t stop healing and the process continues, adding more and more collagen. This build-up of collagen results in an enlarged and raised scar that is either pink, red, skin-coloured or darker than the surrounding skin.

Why some people are more prone to keloid scarring is genetically determined, and depends on the individual’s genetic predisposition. People with darker skin are more prone to develop keloids. Certain parts of the body are also more prone to develop keloid scarring like the chest, shoulders and upper arms.

How do steroid injections work on keloid scars?

Steroids are believed to work by reducing the collagen deposits during the wound healing process and any inflammation in the area. They can be given in a cream form or injected into the scars directly. Injecting steroids has been proven to be more effective as creams don't always penetrate the tough surface of a keloid scar well enough.

Is treatment 100% effective? Will I continue to develop keloid scars?

There is no guarantee that the treatment will be 100% effective, but in most cases, it will improve a lot with steroid injections alone or in combination with other treatments.

If you have a genetic tendency to develop keloid scarring, then you will likely continue to develop these after any future trauma or injury. It is therefore important to avoid any unnecessary treatments.

What risks are involved?

The procedure can be mildly painful. The scar may not improve consistently at the beginning as some parts of the scar may be thicker and tougher than others. But, after multiple sessions, (usually 3-4) you can expect good results.

The steroid given is local to the skin, therefore, it does not cause any major problems or complication with the rest of the body.

What is my next option if steroid injections don’t work?

Steroid injections will work for most scars. If some scars are too tough for an injection, the treatment may need to be combined with surgery and lasers. Various other treatments like creams and silicone gels can also be used to improve the scarring.

If you have a keloid scar and would like to start treatment, visit Dr Mohammed Shareef’s Top Doctors’ profile and check his availability.