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Scars and Keloids

What are scars and keloids?

A scar is permanent fibrous tissue that replaces normal skin after an injury.  Scars are a natural part of wound healing and may result from cuts, burns, piercings, diseases, surgery and acne.  The scar develops as the skin heals the wound and consists of increased fibrous tissue called collagen, which is produced by fibroblasts. These are regenerating cells that are normally found in the skin. Most scars are a normal part of life and nearly everyone has at least a few. 

In contrast, keloids are raised, thickened and tender scars resulting from an excessive healing response in the skin. Not everyone gets keloids although everyone is capable of making a scar after a skin injury.

Who gets scars and keloids?

A scar may form in anyone who gets a sufficiently deep injury to the skin.  Scars may occur from infancy to advanced age.  Keloids are more common in teens and adults and are far less prevalent in older people.  Scars occur in all ethnicities and skin types, whereas keloids are more common in darker skin types, especially those of sub-Saharan African or Asian descent. 

What do scars and keloids look like?

Initially, scars are red or pink (in lighter skin types) but may be red or dark brown in people with darker skin color. Scars typically improve and lighten with time, becoming white or light pink.  This improvement is most dramatic in the first year after the initial injury. Most scars are flat, but some may be atrophic (sunken in) or hypertrophic (raised and thickened).  Normal scars remain confined to the area of initial injury.  Keloids may develop in a previously flat scar a few months after the preceding injury and are raised, thickened, reddish or dark brown and often have claw-like borders.  Keloids may enlarge and extend beyond the area of previous injury on the skin.

Where do scars and keloids occur?

Scars may develop anywhere on the skin where an injury occurs.  Commonly they are seen on arms and legs from trauma, but surgical scars are common on the abdomen, head and neck.  Keloids may also occur anywhere on the skin, but are far more likely to occur on the upper chest, shoulders, upper back and ear lobes (from piercings).

What are the symptoms of scars and keloids?

Most normal scars have no symptoms but occasionally may be dry or itchy.   Keloids, on the other hand, are commonly tender or itchy.  Occasionally, the symptoms may be severe. Some thickened scars or keloids may inhibit movement (called contractures) especially if they are large and occur over a joint.

How are scars and keloids treated?

Many scars do not require treatment unless they are symptomatic or cosmetically concerning.  A dermatologist can provide many treatment options including topical retinoids, intra-lesional injections, chemical peels, dermabrasion, platelet rich plasma (PRP) microneedling and laser.  For more extensive scars, surgical removal of the scar tissue with a scar revision may be done.  Even without treatment, most scars improve and fade over time.  This is especially true in the first year after scar formation.  For scars occurring after surgery, daily massage with bland emollients may be beneficial in addition to sun protection and sunscreen over the scar.   Topical vitamin E and onion extract (found in Mederma) have been shown to be ineffective in scar treatment.  

Conversely, keloids often require more aggressive treatment or a series of treatments.  These may include cryotherapy (freezing), steroid intra-lesional injections, laser, and radiation.  Shaving or surgically removing keloids is done infrequently since there is a high risk of recurrence which may actually result in worsening of the keloid.  Over-the-counter silicone gel pads and pressure applications have some evidence for improving hypertrophic (thickened) scars and keloids.

Acne scarring is a common concern and may result after inflammatory or cystic acne.  The first goal is to control and clear the acne.  Your dermatologist can provide several treatment options, including isotretinoin.  This is a very effective treatment and for some people may actually permanently clear the acne and improve scarring.  Other options include topical retinoids such as tretinoin cream, a prescription medication that treats acne as well as improves scarring when used for about 6 months. More aggressive treatments include chemical peels, TCA CROSS (trichloroacetic acid chemical reconstruction of skin scars), subcision, dermabrasion and laser.

While a scar will not completely go away, proper wound care and treatment may improve the final appearance.  If you have concerns about scarring, schedule an appointment today with a board-certified dermatologist at Iowa Dermatology Consultants to learn about your treatment options.

Scar and Keloid Resources

Links to Additional Information:

AAD Video: How to Minimize a Scar

Why Iowa Dermatology Consultants?

Iowa Dermatology Consultants believes in a patient focused approach to care.  We work with patients forming an active partnership in treatment to help repair the physical and emotional damage of skin disease.  Our Ankeny and Ames locations allow us to conveniently treat patients across the Des Moines metro area and all of Central Iowa including Ames, Carroll, Fort Dodge, Iowa Falls, Marshalltown, Huxley, Slater, and Indianola.  

At Iowa Dermatology Consultants, all of our physicians are board-certified dermatologists. Your care provided by Dr. Snider, Dr. Smith, or Dr. Myers is founded in knowledge and experience which exceeds that of a general practitioner.  Together they have almost 50 years of combined experience in diagnosing and treating a vast array of skin conditions.  This includes over 16,000 hours of patient care training to ensure that a board-certified dermatologist can expertly diagnosis and treat over 3000 dermatologic conditions.

Whether you’re coming to us for help with skin cancer or diseases like acne, psoriasis, and eczema; or to reverse the signs of aging with Botox, chemical peels or other cosmetic procedures, at Iowa Dermatology Consultants you will be getting the best dermatologic care in Central Iowa.