Keloid Scars

A keloid is a benign overgrowth of scar tissue that forms after the skin has been injured. The injury may be minor, such as acne, a piercing, or a small cut, or it may follow surgery, burns, or trauma. During normal healing, the body produces collagen to repair the damaged skin. In some individuals, the collagen response becomes excessive. Instead of stopping once the wound is closed, the body continues to produce thick bundles of scar tissue that extend past the original site.

Keloids often appear as firm, smooth, shiny growths that may be pink, red, brown, or darker than the surrounding skin. They can develop anywhere, but they are most common on the chest, shoulders, upper back, jawline, and earlobes. Acne-related keloids frequently form on the chest, shoulders, and along the jaw or neck, particularly in patients with inflammatory acne.

Keloids are different from hypertrophic scars. While both are raised, hypertrophic scars remain confined to the original wound and may gradually improve. Keloids extend beyond the original injury and rarely regress without treatment.

Evaluation begins with a detailed history. Dr. Richey will ask when the scar first appeared, whether it has grown, and whether it causes symptoms such as itching or pain. Evaluation also includes assessing the size, location, and thickness of the scar, as these factors influence treatment planning. For acne-related keloids, controlling active acne is an essential part of preventing new lesions.

In most cases, no biopsy is required. However, if a lesion has an unusual appearance or changes rapidly, a biopsy may be considered to rule out other conditions. As a Mohs surgeon with extensive experience in skin cancer diagnosis, Dr. Richey carefully distinguishes keloids from other growths when needed.