Keloids are more frequent in darker-skinned patients. They tend to appear on the upper trunk, especially the upper back and mid chest, and on deltoid areas. Unlike hypertrophic scars, keloidal scar tissue extends beyond the margins of the wound or injury. They may appear spontaneously.
Keloids are shiny, firm, smooth, usually ovoid but sometimes contracted or webbed, and slightly pink or hyperpigmented.
Treatment of keloids is often ineffective.
Monthly corticosteroid injections (eg, triamcinolone acetonide 5 to 40 mg/mL) into the lesion sometimes flatten the keloid.
Surgical or laser excision may debulk lesions, but they usually recur larger than before. Excision is more successful if preceded and followed by a series of intralesional corticosteroid injections. Gel sheeting (applying a soft, semiocclusive dressing made of cross-linked polymethylsiloxane polymer, or silicone) or pressure garments are other adjuncts to prevent recurrence.
More recently, immunomodulators (eg, topical imiquimod) have been used to prevent keloid development or recurrence.