SKIN CONCERNS: Scars

Scars

Abnormal healing of the skin occurs frequently in individuals with brown skin. When skin is injured, it may heal with one of several types of scars: normal (level with the surrounding skin), atrophic (depressed), hypertrophic (slightly raised), and keloidal (large and raised).

Most injuries or wounds in people with skin of color heal with normal scars. However, when abnormal scars do develop in individuals of African, Latina and Asian descent, one of the most common types is keloidal scarring.

Keloidal Scarring on Brown Skin

Although keloids have been seen in people of all races, individuals with skin of color are affected more often than those of European descent. In a predominantly Black and Hispanic population, the incidence of keloid formation was found to be between 4.5% and 16%.

Unlike "normal" scars, keloids do not necessarily develop immediately after the injury or wound to the skin. The onset is often delayed by months or in some cases by years. Whereas the injury to the skin may be small, as in the case of ear piercing, keloids are inappropriately large.

Keloids are due to an over-production of scar tissue that is made of the building block of the skin, collagen. The exact cause of collagen over-production remains unclear, but is probably due to several factors, including an abnormality in cells in the dermal layer of the skin called fibroblasts, which overproduce collagen, elastin, fibronectin, and proteoglygans and display abnormal responses to both stimulation and greater proliferative capacity. Additionally, there may be an abnormality in various growth factors in the skin, including one called transforming growth factor beta.

Since we do not know the exact cause of keloids, we have not identified the perfect treatment. However, there are several useful and effective treatments for keloids.

Treatment Options

• Excision or surgical removal
• Laser therapy
• Radiation treatment
• Corticoteroids - As injections or topical creams
• Interferon injections
• Pressure treatments
• Silicone gel or sheets

Bottom Line

Keloids can be very difficult and frustrating to treat. None of the currently available treatments work in all cases. At times, multiple treatments will be necessary and they still may not completely reduce or eliminate the keloids. What is most important is that you give the treatment at least 4-6 months to work.