Derms Explain What Causes Keloid Scars, and the Best Ways to Keep Them at Bay
When you get a cut or wound, you don’t question that your skin will heal it. You assume that it will because, well, it’s skin, and your body’s largest organ always delivers—except when it doesn’t.
Whenever your skin experiences trauma or a wound, it works to heal the area by laying down a protein called collagen, which forms a scaffolding with other proteins to support healing, says Erum Ilyas, M.D., board-certified dermatologist in Audubon, Penn., and creator of AmberNoon, a sun-protective clothing line for women. Yet in some cases, you can get a scar gone wild. “When the collagen is laid down in a haphazard fashion and grows beyond the areas of the wound, a keloid develops.”
Fortunately, while keloids don’t spread to other areas of the body, they do grow locally. The good news, however, is they can be treated and sometimes prevented if you know what to do.
What Causes Keloid Scars?
Any wound can cause a keloid scar, says Paul Jarrod Frank, M.D., a cosmetic dermatologist in New York City and the founder and chief medical officer of the PFRANKMD Brand. Common triggers for developing a keloid scar include body piercings, tattoos, and any type of surgery, essential or cosmetic. They do have a strong genetic component, though, which is why he advises people who are susceptible to these scars to avoid having elective surgeries, if possible.
Keloid scars can also develop without an apparent cause. “The most frustrating ones are those that pop up without any obvious trigger,” Dr. Ilyas says. These are often related to acne, and they’re especially common in men on the back, shoulders, and mid-chest.
Although keloid scars may cause some pain or discomfort, the most common complaint is skin itching. “Keloid scars are filled with mast cells, the same cells in the body that release histamine in response to an allergic reaction, making those scars itchy,” Dr. Ilyas explains.
How to Prevent and Treat a Keloid Scar
Keloid scars aren’t always easy to prevent, but it can be done, starting with being proactive about optimizing your healing. “Contrary to popular belief, the time to intervene with scars is sooner rather than later,” Dr. Frank says. Keep the wound clean and moist to prevent it from getting infected.
After primary healing has taken place, generally within 10 to 14 days when the wound has closed over, apply silicone scar sheets that are available over the counter. These sheets apply pressure to the wound, which can promote healing. “That pressure alone signals to the body not to build that wall,” Dr. Ilyas says. Not only are these sheets effective, especially if you’re prone to keloids, they also don’t cost much. Use them for six weeks.
Then Dr. Ilyas recommends massaging your wound with gentle pressure for at least 10 to 30 seconds every night. That massaging will help flatten the wound and stimulate healing. If you need something slippery to help your fingers glide over the wound, use a gentle emollient or ointment like Vaseline, Vitamin E, or coconut oils, which contain antioxidant and anti-inflammatory benefits to assist in healing.
Some keloid scars do require treatment, but if you catch them early, treatment needs are minimal. Along with silicone scar sheets, it usually involves injectable agents like cortisone or Kenalog, even a chemotherapeutic agent called Five Fu, Dr. Frank says. He’ll often combine this with therapies like VBeam or Dye Laser Therapy. “This [halts] blood supply causing the scar to be red and thick,” he says.
Suffered a wound but haven’t yet gotten a keloid scar? If you’re three months into your wound healing—the exception being if you have inflammation or an infection or a foreign object like dissolving stitches that delays wound healing, Dr. Ilyas says—you’re most likely in the clear.