Keloid

Last Updated: 2022-03-25

Author(s): Anzengruber F., Navarini A.

ICD11: EE60.0Z

Alibert, 1816

Bead scar, scar proliferation, scar keloid.

Enlarged scar due to connective tissue proliferation (collagen type I).

  • Especially young adults
  • Increased risk with the following geographical origin
    • Africans (up to 20-fold higher incidence compared to Caucasians)
    • Asians

  • After trauma or spontaneously
  • Increased collagen synthesis (structural proteins are replaced mainly by collagen type I)

  • Especially in the face, pre-sternally, and on the upper arms, there are exophytic, hypertrophic, skin-coloured, coarse palpable, sharply delimited, plate-like or nodular bulges, often with telangiectasia
  • Loss of hair
  • Unlike a hypertrophic scar, the keloid extends beyond its original boundaries

  • Clinical
  • Biopsy to delineate differential diagnoses, if necessary

Trunk, face, upper arms.

  • Intralesional cortisone injection with for example triamcinolone 10mg or 40mg.
    • ideally cryotherapy beforehand, as this can soften the sometimes extremely hard tissue for the injection with a waiting time of a few minutes
    • Only inject with Luer-taper syringe, otherwise the syringe attachments often burst away due to the strong pressure and the injection solution can splash around
  • Clobetasol cream/ointment occlusive
  • Compression therapy
  • Cryosurgery: 2 x 15 seconds, with funnel
  • Laser (ablative)
  • Surgical removal: high risk of recurrence, with brachytherapy if necessary

  1. Addison T. On the Keloid of Alibert, and on True Keloid. Journal of the Royal Society of Medicine 1854;MCT-37:27-47. 
  2. Rubenstein R, Roenigk HH, Stegman SJ, Hanke CW. Atypical keloids after dermabrasion of patients taking isotretinoin. Journal of the American Academy of Dermatology 1986;15:280-5. 
  3. Berman B, Duncan MR. Short-term keloid treatment in vivo with human interferon alfa-2b results in a selective and persistent normalization of keloidal fibroblast collagen, glycosaminoglycan, and collagenase production in vitro. Journal of the American Academy of Dermatology 1989;21:694-702. 
  4. Granstein RD. A Controlled Trial of Intralesional Recombinant Interferon-? in the Treatment of Keloidal Scarring. Arch Dermatol 1990;126:1295. 
  5. Larrabee WF, East CA, Jaffe HS, Stephenson C, Peterson KE. Intralesional Interferon Gamma Treatment for Keloids and Hypertrophic Scars. Archives of Otolaryngology - Head and Neck Surgery 1990;116:1159-62. 
  6. Glenn MJ, Bennett RG, Kelly AP. Acne keloidalis nuchae: Treatment with excision and second-intention healing. Journal of the American Academy of Dermatology 1995;33:243-6. 
  7. Sclafani AP, Gordon L, Chadha M, Romo T. Prevention of Earlobe Keloid Recurrence with Postoperative Corticosteroid Injections Versus Radiation Therapy A Randomized, Prospective Study and Review of the Literature. Dermatologic Surgery 1996;22:569-74. 
  8. Bernestein LJ. Keloid Formation With the 585-nm Pulsed Dye Laser During Isotretinoin Treatment. Arch Dermatol 1997;133:111. 
  9. Berman B, Flores F. Comparison of a Silicone Gel-Filled Cushion and Silicon Gel Sheeting for the Treatment of Hypertrophic or Keloid Scars. Dermatologic Surgery 1999;25:484-6. 
  10. Alster TS, Handrick C. Laser treatment of hypertrophic scars, keloids, and striae. Seminars in Cutaneous Medicine and Surgery 2000;19:287-92. 
  11. Kelly AP. Pseudofolliculitis barbae and acne keloidalis nuchae. Dermatologic Clinics 2003;21:645-53. 
  12. Dinh Q, Veness M, Richards S. Role of adjuvant radiotherapy in recurrent earlobe keloids. Australas J Dermatol 2004;45:162-6. 
  13. Lee S-S, Yosipovitch G, Chan Y-H, Goh C-L. Pruritus, pain, and small nerve fiber function in keloids: A controlled study. Journal of the American Academy of Dermatology 2004;51:1002-6. 
  14. Fikrle T, Pizinger K. Cryosurgery in the Treatment of Earlobe Keloids: Report of Seven Cases. Dermatologic Surgery 2005;31:1728-31. 
  15. Davison SP, Mess S, Kauffman LC, Al-Attar A. Ineffective Treatment of Keloids with Interferon Alpha-2b. Plastic and Reconstructive Surgery 2006;117:247-52. 
  16. Treatment of keloid scars post–shave excision with imiquimod 5% cream: A prospective, double-blind, placebo-controlled pilot study. Journal of the American Academy of Dermatology 2008;58:AB10. 
  17. Mofikoya BO, Adeyemo WL, Abdus-salam AA. Keloid and Hypertrophic Scars: A Review of Recent Developments In Pathogenesis And Management. Nig Q J Hosp Med 2008;17. 
  18. Smith JC, Boone BE, Opalenik SR, Williams SM, Russell SB. Gene Profiling of Keloid Fibroblasts Shows Altered Expression in Multiple Fibrosis-Associated Pathways. Journal of Investigative Dermatology 2008;128:1298-310. 
  19. Ikeda M, Naitoh M, Kubota H, et al. Elastic fiber assembly is disrupted by excessive accumulation of chondroitin sulfate in the human dermal fibrotic disease, keloid. Biochemical and Biophysical Research Communications 2009;390:1221-8. 
  20. Ogawa R, Yoshitatsu S, Yoshida K, Miyashita T. Is Radiation Therapy for Keloids Acceptable? The Risk of Radiation-Induced Carcinogenesis. Plastic and Reconstructive Surgery 2009;124:1196-201. 
  21. Wolfram D, Tzankov A, Pülzl P, Piza-Katzer H. Hypertrophic Scars and Keloids—A Review of Their Pathophysiology, Risk Factors, and Therapeutic Management. Dermatologic Surgery 2009;35:171-81. 
  22. Katayama Y, Yamawaki S, Yoshimura M, et al. Severe Acute Radiodermatitis in a Keloid Patient with Takayasu's Arteritis. Plast Reconstr Surg Glob Open 2014;2:e270.