Keloid scarring is an occasional complication secondary to surgical wounding or trauma. It is characterized by excessive growth of scar tissue beyond the boundaries of the original wound. Certain wound sites are more prone to keloids and include the ear, secondary to piercing, the outer shoulder area and the pre sternal or chest area. Certain races including people of Asian or African descent are more prone to keloids.
The pathology is thought to be in the loss of regulation of mast cell activity in wounds.
Treatment of keloid scarring has not improved greatly despite a better understanding of the cell activity. Injecting keloids with kenacort is useful in ameliorating symptoms such as redness and itching. Surgery is usually contraindicated as the keloid will almost certainly recur.
The only time I will consider surgery is if this is combined with a short course of radiotherapy. This requires a compliant patient and the services of a Radiation specialist. It is worth considering when the keloid places a significant cosmetic burden.