Keloids may look bad, but they are harmless

Q. I am a 46-year-old African-American man with keloids on my chest. My first problem is that I don't like how they look. But I'm also worried about other effects — are keloids a threat to my overall health?

A. First, let me calm your fears: Keloids are harmless. Because keloids look like growths, some of my patients who have them are worried they may turn into cancer. You may not like how they look, but they do not become cancerous. And they don't cause other serious health effects, either.

But as you point out, keloids can affect your appearance. So what are they? Keloids are raised overgrowths of scar tissue that occur at the site of a skin injury. They occur where trauma, surgery, blisters, vaccinations, skin infections, acne or body piercing have injured the skin. For reasons we don't understand, the healing response has gone a little overboard. Keloids continue to grow after the original wounds have healed. That's why they form bumps on the flat surface of the skin.

Keloids are shiny, smooth and rounded, and may be pink, purple or brown. They can be doughy or firm and rubbery to the touch, and they often feel itchy, tender or uncomfortable. A large keloid over a joint may interfere with joint function. Now and then, I've seen keloids in places where the skin has not been visibly injured.

Some people are prone to keloids and may develop them in several places. They can crop up anywhere on the body, but they commonly appear on the shoulders, upper back and chest.

Keloids usually appear between the ages of 10 and 30. They affect both sexes equally, but they may be more common among young women with pierced ears. Keloids are also more common in African-Americans.

Keloids may continue to grow slowly for weeks, months or years. They eventually stop growing, but do not completely disappear on their own. Once a keloid develops, it is permanent unless removed or treated successfully. Keloids that are removed often come back.

I generally recommend non-surgical treatment. The most commonly used treatment, which works in about 70 percent of people, is injection of the keloid with anti-inflammatory medicines called corticosteroids. Other medicines also can be injected into keloids, but they are not as well proven. Sheets of silicone gel placed over a keloid may help deal with the symptoms. Laser treatments and treatments with extreme cold have also been used, but, again, are not as well proven.

If you decide to pursue treatment for a keloid scar, you will have the best results if you start treatment soon after the keloid appears.

To reiterate, keloids are primarily a cosmetic concern and not a health threat. If a scar becomes enlarged, itchy, uncomfortable, interferes with the movement of a joint or creates an unacceptable cosmetic effect, discuss treatment options with your doctor.

• Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: AskDoctorK.com.