Keloids are a type of raised scar that occurs on the skin after an injury heals. Keloids develop when scar tissue continues to form after the skin healing process ends. They are more common in people of African, Asian, and Hispanic descent.
Keloids can grow quite large, and they can be bothersome. However, people can take some steps to prevent keloids, and treatments are available.
Keep reading to learn about the causes, appearance, prevention, and treatment of keloids on black skin.
Although the exact causes remain unclear, the British Association of Dermatologists suggest that keloids develop when the body produces too much collagen during the formation of a scar in response to an injury.
Collagen is a protein that the body produces to maintain elasticity in the skin. It also gives structural support to the muscles, bones, and tissues.
The American Academy of Dermatology Association (AAD) note that keloids can develop as a result of the following:
- puncture wounds
- severe acne
- insect bites
- surgical scars
- injection sites
- tightly braided hair
In rare instances, keloids may form when individuals have not had a skin injury. These keloids, which doctors call spontaneous keloids, typically appear on the chest and develop in those who have a family history of developing keloids.
According to the AAD, the first sign of a keloid appears roughly 3–12 months after an injury. It may initially appear as a red, pink, or purple scar but will eventually turn darker than the person’s skin. The border is also usually darker than the center.
The British Skin Foundation (BSF) add that these scars may appear as shiny and hairless skin lumps.
Keloids tend to grow slowly, with most continuing to spread for weeks, months, or, sometimes, even years. In some cases, though, they may grow quickly and triple in size within a few months.
The appearance and texture of keloids may also differ depending on their location. A keloid on an earlobe is usually round and firm, while on other parts of the body, it may appear as a raised scar with a flat surface. Keloids will feel different than the surrounding skin and may be either soft and doughy or hard and rubbery.
Most keloids are solid and do not move. On some parts of the body, such as the neck, abdomen, or ear, a keloid may hang by a stalk and move slightly when a person touches it.
Keloids can vary in size from smaller than an inch across to larger than a football. It is also not uncommon for a keloid to feel tender, itchy, or painful while growing. These symptoms usually resolve when the keloid stops growing.
The AAD state that in the United States, keloids are more common in people of Asian, Hispanic, and African descent. The BSF also note that although keloids can affect anyone, they are more common in people with darker skin types.
According to research, the incidence of keloids in these individuals ranges from 4.5% to 16%.
Keloids are also more likely to occur in people:
- with a family history of keloids, particularly those of African or Asian descent
- experiencing hormonal upsurges, such as during pregnancy or puberty
- with systemic conditions, such as hypertension
- between the ages of 10 and 30 years
- with rare conditions, such as Rubinstein-Taybi syndrome and Goeminne syndrome
Although it may be difficult for people at higher risk to prevent keloids, they can take steps to reduce their chances of developing a keloid. These include:
- Paying close attention after an ear piercing: If a person notices the first sign of thickening, wearing a pressure earring may help prevent the keloid from forming.
- Testing the skin before a tattoo, body piercing, or cosmetic surgery: By testing a small area of skin, people can see how their skin will react. Wearing a pressure garment may help stop the skin from thickening.
- Telling a surgeon before surgery: The surgeon may be able to use a technique to reduce the likelihood of keloids developing. Keloid treatment may also help prevent thickening.
People can also ensure that they practice proper wound care after any skin injuries. This may involve:
- washing the area immediately using soap and clean water
- using sterile petroleum gauze to bandage the area
- cleaning the wound daily until it has healed
- protecting the wound from the sun
In addition to the above measures, people can visit a dermatologist, who may be able to suggest treatment plans and prevention strategies.
Options for treatment include both surgical and nonsurgical procedures. In some cases, a combination of two methods may be most effective.
The AAD state that doctors may use the following nonsurgical treatments for keloids:
Corticosteroid shots are anti-inflammatory drugs that a doctor injects into a keloid to shrink it. The typical regimen involves one injection per week for 4 weeks, which results in 50–80% shrinkage. However, many keloids come back within 5 years.
Cryotherapy involves freezing a keloid while preserving the skin beneath it. Doctors use this technique to decrease the size of the keloid. Optimal results come with three or more treatments, and it may work better for smaller keloids.
Laser treatment involves delivering highly focused beams of light to the skin. It may reduce the height of the keloid and fade its color.
Ligature involves tying a surgical thread around a keloid every 2–3 weeks. This thread cuts into the scar and gradually causes it to fall off.
A doctor can surgically remove a keloid. However, this is not a permanent solution because almost 100% of keloids reoccur after surgery. To lower the risk of a keloid return, doctors often recommend an additional treatment after surgical removal.
Combination of surgical and nonsurgical treatments
The AAD note that the following treatments fit into this category:
- Surgery then radiation: Radiation is the application of beams of intense energy to the scar. It can be a stand-alone treatment, but it is more effective in combination with surgery.
- Surgery then a pressure dressing, earring, or garment: Doctors often recommend this combination following earlobe surgery, using a pressure earring to reduce blood flow to the area. It is 90–100% effective in preventing a keloid from returning. The problem is that these devices are not comfortable, and people must wear them for up to 16 hours a day for 6–12 months.
- Surgery then corticosteroids or cryotherapy: Either of these treatment combinations may help reduce the risk of recurrence.
Some commonly asked questions may include:
Can keloids flatten naturally?
Keloids never completely go away, but they sometimes flatten without treatment. A 2014 study found that this happens in approximately one-third of cases and that the keloids that disappear spontaneously do so early.
Are keloids symptoms of a more serious condition?
Keloids are more of a cosmetic issue than a health problem. They do not turn into cancer.
Keloids are common on black skin and may occur after severe acne, a piercing, or any type of skin injury, such as a cut or puncture wound. Their size and shape can vary depending on the part of the body where they appear.
Treatment options include surgical removal and an array of nonsurgical options, including corticosteroid injections and cryotherapy. Sometimes, doctors recommend a combination of treatments to reduce the likelihood of a keloid returning.