These bumps can be difficult to identify and treat, so we’re here to give you the lowdown on what keloid scars are, what causes them, how to prevent them, and finally, how to treat an already present keloid. Let’s get into it. Miller said keloids often present as firm, itchy, or painful bumps over sites of previous injury to the skin. This could be a piercing, general skin trauma, or a lesion (such as an acne cyst). It’s important to note that an initial bump on the site of a new piercing is very different from a keloid. According to the American Academy of Dermatology (AAD), keloids tend to appear over three to six months, begin as a raised scar on the surface of the skin, and grow slowly. Piercing bumps, on the other hand, present as swelling beneath the skin’s surface and should get smaller week after week post-piercing and eventually disappear altogether, Loretta Ciraldo, M.D., FAAD, previously told mbg. Additionally, keloids shouldn’t be confused with just any raised scar either. To put things into perspective, keloids have three times more collagen1 (e.g., the protein that gives structure to the skin) than hypertrophic scars, or thick raised scars. According to the AAD, “About one-third of people who get keloids have a first-degree blood relative (mother, father, sister, brother, or child) who gets keloids. This family trait is most common in people of African or Asian descent.” While it’s always best practice to follow strict aftercare regimens for piercings, skin injury alone can cause a keloid. For this reason, Miller suggests high-risk patients consider avoiding elective procedures in areas prone to keloid formation like the chest, upper back, and ears. While most keloids are caused by scars, there are “spontaneous keloids” that can form on uninjured skin. The AAD said this mainly happens in those with a history of keloids, personal or familial, and when this happens it’s likely that a few keloids will present at once. As of now, professionals are still unsure what mechanisms in the body make some people scar in this way. However, research has indicated that chronic inflammation plays a role in their formation2, much like most scar tissue. “Following trauma or procedures, proper wound care should be undertaken to avoid infection. Once healing begins, a silicone-based scar sheet should be applied as soon as possible over the area,” Miller said. Further, massaging scar tissue with a silicone gel can also be helpful in keloid prevention. (This story has several silicone-based options for scar prevention.) In regard to ear piercings, the AAD suggests paying extremely close attention to how the injury heals. If you begin to feel the skin on the piercing area begin to thicken, you should remove the piercing and replace it with a pressure earring instead. “Most dermatologists will offer intralesional steroid injections as the first line of therapy, which after several treatments can decrease the thickness of many keloids,” Miller explained. As board-certified dermatologist Keira Barr, M.D., also notes, “laser and light-based therapies3 can be used as well.” In fact, a review of 33 studies found that LED light therapies and CO2 lasers (two therapies that were more widely studied) may enhance patient outcome in particular. While this may work for most keloids, especially those caught early on, it may take further treatment to remove more stubborn ones. “For resistant keloids, intralesional treatment with off-label chemotherapy products, surgery, and radiation therapy have been reported to help. Often multiple therapies are combined,” Miller explains. These are, of course, serious treatments, and so please be sure to have thorough conversations with your medical practitioner about your options and what’s right for you.
