Surgery

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Keloid scars

What are keloid scars

Keloids are raised, bumpy, firm or rubbery scars that result from an abnormal healing response to skin injury. Unlike other scars, keloids outgrow the original wound boundaries. This means that an injury as small as a pinprick, such as from an insect bite, spot or ear piercing, can become a large keloid scar. No one yet knows the underlying cause of the abnormal healing that leads to keloid scars; it is an area of ongoing research.

Keloid facts

• Keloids are composed of thick scar tissue and are the result of an over-production of collagen in the scar during healing.
• They can continue to grow over a period of months or even years.
• Their colour can be very different to that of surrounding skin, varying from flesh-coloured to pink, red or dark brown.
• Keloids are more common in darker skin types.
• Keloid scars can bleed and become infected.
• They can affect any area of skin, but the most common areas include the shoulders, upper back and chest, neck, ears and face.
• If someone develops a keloid scar on one part of their body, their skin may still heal normally in other body areas.
• Keloid scars are benign and non-contagious.

How might keloid scars affect me?

People with keloid scars can suffer from a number of symptoms which can impact on their daily life and make the scars difficult to live with.

Keloid scars can cause physical symptoms of:

• Pain
• Itching
• Restriction of movement

Keloid scars can have negative effects on people’s wider lives too. The following are quotes from people with keloid scars which demonstrate some of the ways they can affect their lives:

Social life:

“I feel I can't wear the clothes I like because I worry people will see my scars.”

“Now I feel self-conscious about going swimming.”

Work life:

“My scar makes me uncomfortable while writing.”

“I find manual work difficult because of my scar.”

Relationships and sex life:

“Because of my scar I don’t feel confident undressing myself in front of my husband.”

“It stops me from enjoying my sex life so much.”

Psychological wellbeing:

“Sometimes I feel depressed because my scar.”

“My scar has made me more self-conscious and I am not confident with myself anymore.”

What treatments are available?

A number of treatments for keloid scars can be accessed through the nurse led keloid clinic at the Royal London Hospital. These include:

Conservative management

This involves application of silicone gel or sheets, use of steroid tape or sheets, pressure garments and pressure earring.  The nurse will also guide you in how best you can massage and manage your scar during the healing phase.

Intralesional Steroid Injection

Steroid is administered directly into the scar tissue every six to eight weeks. This helps flatten and soften the scar, it helps reduce discomfort such as pain and itchiness. The number injections needed varies, larger and or older keloid scars requires longer period of treatment

Intralesional Excision (Surgery)

This surgical procedure can be done to reduce the size of larger keloid scars before commencing regular steroid treatment. The scar tissue is removed from within the keloid boundaries, without harming normal surrounding skin to avoid producing further scaring.  This can be done as a minor procedure or as a day case. Further steroid treatment is required following this procedure.

Extralesional excision and radiotherapy

This involves complete removal of the keloid scar then followed by radiotherapy treatment within 48 hours.  This treatment is only available following complete review by the Radiology Team.  Further steroid injection maybe required to treat early recurrence.

Useful websites

 www.nhs.uk – NHS Choices

www.bapras.org.uk  - The British Association of Plastic, Reconstructive and Aesthetic Surgeons is the professional representative body for plastic and reconstructive surgeons in the United Kingdom. Get an overview of the work of the association, and authoritative advice on management of conditions.

www.bartshealth.nhs.uk - Barts Health NHS Trust website.

www.skincamouflage.net - British Association of Skin Camouflage

Useful contact numbers

If you have any queries or concerns about your scar, contact the clinical nurse specialist on 020 3594 6668

Department of Plastic Surgery

020 7377 7192 or 020 3594 6034

Translation and interpreting services

If you do not speak English as a first language, use sign language (BSL) or have a learning difficulty, our in-house Bilingual Health Advocacy and Interpreting Service can help.

St Bartholomew’s, Mile End and The Royal London Hospitals
Telephone: 020 7377 7000 

Newham University Hospital
Telephone: 020 7476 4000 

Whipps Cross University Hospital
Telephone: 020 8539 5522 

Text Relay service for Deaf people
Our dedicated number is 18002 and then add in the number you are wanting to phone. It is available 24/7 for deaf people to access emergency services through interpreters across our hospitals. 

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Patient Advice and Liaison Service (PALS)
Please contact us if you need general information or advice about Trust services: www.bartshealth.nhs.uk/pals

Reference: BH/PIN/211

Publication date: Dec 2020

All our patient information leaflets are reviewed every three years.

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