Understanding Keloid Scars: Causes, Symptoms & Advanced Treatment Options

For many patients in South Africa, a simple ear piercing, minor scratch, or surgical incision can trigger an unexpected and frustrating reaction: a thick, raised, itchy scar that continues to grow well beyond the original wound boundary.

This condition is known as a keloid scar. Unlike normal scars that fade over time, keloids represent an active, aggressive overproduction of collagen. Understanding the biological nature of keloids is the essential first step toward effective management.

What Exactly Is a Keloid?

A keloid is a benign, non-cancerous fibrous growth that forms in the reticular dermis of the skin. When the skin experiences an injury, the body initiates wound healing by sending fibroblasts to synthesize collagen. In individuals genetically predisposed to keloids, the cellular "stop" signal fails to activate. Fibroblasts continue to deposit dense, disorganized collagen bundles (predominantly Type I and Type III collagen), causing the scar to balloon outward.

Keloids vs. Hypertrophic Scars: The Crucial Difference

Patients frequently confuse keloids with hypertrophic scars. While both are raised scars, their clinical behavior differs fundamentally:

• Hypertrophic Scars: Remain strictly confined within the boundaries of the original injury. They often improve spontaneously over 12 to 18 months and respond rapidly to topical pressure or silicone therapy.
• Keloids: Actively invade adjacent healthy skin, extending far beyond the original wound margins. They do not regress spontaneously and have a notorious biological tendency to recur if treated inappropriately.

Common Anatomic Sites for Keloid Formation

While keloids can arise anywhere on the body, they predominantly develop in areas with high resting skin tension, increased sebum production, or frequent movement:

• Earlobes and Cartilage: Commonly triggered by decorative ear piercings.
• Chest and Pre-Sternal Area: Prone to high skin tension and acne-induced keloids.
• Shoulders and Upper Back: Sites of frequent tension during movement.
• Jawline and Neck: Often provoked by folliculitis, shaving bumps, or acne lesions.

The Modern Multimodal Treatment Approach

In the past, patients were often told that nothing could be done, or lesions were simply cut off—only to grow back larger. Modern plastic surgery recognizes that monotherapy (using just one treatment) rarely succeeds. At UNAKA Medical Aesthetics, Dr MP Madzhia utilizes an individualized multimodal strategy:

1. Intralesional Corticosteroids

Targeted micro-injections of triamcinolone acetonide directly into the dense core of the keloid reduce inflammatory mediators, inhibit fibroblast proliferation, and flatten the scar over a sequence of visits.

2. Medical Silicone Therapy

Medical-grade silicone gel sheets create a sealed, hydrating micro-environment that increases stratum corneum hydration and reduces capillary activity, softening firm scar tissue.

3. Precision Surgical Excision with Immediate Adjuvant Therapy

For bulky or pendulous lesions (such as earlobe keloids), surgical core or extranodular excision restores anatomical shape. Crucially, surgery is immediately combined with adjuvant therapies—such as corticosteroid infiltration and pressure clips—to suppress recurrence.

When to Consult a Specialist

If you have a scar that is painful, throbbing, itchy, or growing noticeably over time, early specialist evaluation offers the best prognosis. Prompt intervention halts progressive growth and minimizes the need for extensive interventions.