A keloid is defined as a benign, well demarcated area of fibroid tissue overgrowth that extends beyond the original defect.
Clinically, keloid scars appear as fleshy growths in areas of previous trauma. Lesions appear within 3 - 4 weeks of the causative stimulus (trauma, ear piercing, operative incisions). The lesions are pink or red plaques, which can become very large and classically involve the earlobes, chin, neck or chest. They may grow for months or several years and then tend to spontaneously regress. Lesions can be hypersensitive or very tender. The cause is not known, but both environmental and genetic factors are thought to play a part.
Differentials may include:
Management ideally includes avoidance of unessential trauma to the sites of predilection, in those who are predisposed to keloid scarring. However, this is not always possible. Intra-lesional triamcinolone, pressure bandaging or clipping, pre-op site radiotherapy and silicon gel have all been found to be of use.