Keloids

Bump Description | Bump Creation | Bump Prevention | Bump Treatment | Further Reading

Brief: This page discussed a type of piercing bump known as Keloid scarring. It is a bump often spoken about among piercing enthusiasts but is actually much rarer that people think.


TL;DR – Too much information? For a shorter version try our quick reference guide here!

Keloid Scars

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Keloid Scarring

Keloid scars are perhaps one of the most misunderstood of piercing bumps. Many piercers and enthusiasts mistakenly think that ‘keloids’ are common but more often than not they are actually misdiagnosing hypertrophic scarring or a bump of a different kind. Keloid scars themselves are quite rare and tend to be genetic – meaning you or your family would have had trouble with them before.


Description 

A keloid scar is a skin coloured or purpley-red coloured bump which is hard to the touch and feels rubbery. The bump starts at the site of the piercing but expands away from it often becoming very large and rounded, almost like a mushroom. Keloid scars grow away rapidly from the skin and often form abnormal masses of tissue (neoplasms) or ‘benign tumours’. At times there can be needle like pain or itching associated with the bump. Keloid scars can become infected just like normal skin and if they do they are likely to form ulcers.


Creation

A keloid is created by an overgrowth of granulation tissue cells or proteins while a piercing is healing. Granulation tissue is the delicate new tissue that forms very soon after being pierced as a sort of ‘emergency patch’ which covers the wound and creates a network of blood vessels that brings healing cells and oxygen straight to where they need to be.

The over production of granulation tissue is thought to occur because the delicate balance between cells breaking down to provide energy (catabolic phase) and the energy is used to build new cells (anabolic phase) is disrupted. When this happens more granulation tissue is produced than can be broken down or reabsorbed and so it grows in all directions, rather than just where it is needed, which is what forms the keloid scar.

This over production is caused by uncontrolled signals from the wound cells which call forth more tissue cells than are needed, causing an imbalance and an overgrowth.

It is also thought the overproduction is caused by increased or sustained inflammation (swelling) which is what stimulates granulation tissue placement and collagen (tissue) production. Keloids also seem to have a lot of immune cells (building and healing cells) inside which do not go away with time like they do in hypertrophic scars, perhaps explaining why Keloid bumps spread further.

While keloids are created by an overgrowth collagen type III they also contain a different type of tissue most commonly found in scars (collagen type I) unlike in hypertrophic scarring. As well as this sometimes keloids do not even need a fresh wound to appear and can pop up years after the trauma or with no prior wound. Researchers have yet to discover why this is.

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Prevention

At the moment doctors do not really understand much about keloids so there is very little advice in regards to preventing them from occurring. Anyone can develop a keloid on any wound (even a small scratch) though it is less likely in children under 11 or the elderly and more likely if you have a darker skin tone, a family history of keloid scarring or if you have previously had a keloid occur on a wound. It is also more common on surgical or ‘scalpelled’ wounds such as from the scarification body art form. Females and people with blood group A may also be more prone to keloids. Hydro gel, silicone sheeting and silicone gel can help to prevent keloids on a wound but these would be needed to be worn for up to two months to have a difference. Using these materials on a still healing piercing may cause irritation, affecting healing time and even cause keloiding or hypertrophic scarring. Therefore, they may not be any use for piercings. Look after your body. It is also thought that abnormal healing like hypertrophic scarring happens in wounds due to a lack of certain nutrients. In particular essential fatty acids such as omega 3 (Linoleic and Eicosapentaenoic acid in particular) have been shown to effect wound healing so a cod liver oil supplement could be helpful. As well as this a lack of vitamin A, C and the mineral zinc can also cause problems when healing a wound so a multivitamin may also prevent abnormal healing patterns like hypertrophic scarring from occurring. It is also worth mentioning that keloid bumps are much more common on wounds which heal by secondary intention (stay open as they heal – find out more here) and wounds that have foreign bodies in them, which is essentially what a piercing is. Therefore if you are very worried about bumps or permenant scarring you should seriously reconsider whether getting a piercing is worth the risk.

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Treatment 

Keloids are very difficult to treat as the overgrowth of tissue cannot just be cut away – because this could cause another keloid to form around the new wound. Worse of all even if treatment on a keloid (from any means) is successful there is a risk that the keloid could return, usually within 5 years.


Silicone. Hydrogel, silicone gel (like Dermatix) and silicone sheeting can be used to help stop pre-exisiting keloids from growing any bigger. For some people it has helped their keloid to reduce in size also. It is thought they work by inhibiting the wound signals so that less tissue is called over, working as a second skin so the scar remains well hydrated and protected, and altering the chemical structure of the scar itself. Onion. There have been some research recently into the use of onion or ‘Allium Cepa’ to help with keloids. It is particularly good at reducing scar colour but it also contains a high amount of Quercetin which both inhibits the overproduction of the signalling cells (which cause too much tissue) and reduces the tissue in the bump itself. Best results seem to come by combining silicone sheeting and Allium Cepa. To use simply crush a tablet into powder and either add to a hot soak or mix with an oil to create a paste and apply directly. Fish Oil. Fish oils such as cod liver oil may also benefit keloids due to their high amount of omega 3. A type of omega 3 fatty acid known as Eicosapentaenoic acid significantly inhibits the overproduction of tissue and interrupts the cell signaling process allowing the scar to reduce in size. Omega 3 also contains Linoleic acid which has a similar effect. Steroids. The most common form of treatment is a steroid injection (known as an intralesional corticosteroid injection) either around or in the keloid itself. This has a good rate of success in patients (around 70%) although it can be sore and may have some side effects, such as discoloration of the skin. Compression therapy. This also been reported to be very successful. It is believed to work by reducing blood flow which decreases the amount of new tissue cells getting to the scar and increases the breakdown of collagen (tissue). It also reduces levels of oxygen and water to the wound which the cells need in order to produce the tissue and the tissue needs in order to stay alive, literally ‘killing off’ the bump. Certain enzymes and proteins needed by the overproducing cells are also thought to be restricted using this therapy. Purpose made equipment such as fitted dressings, clothes or clip-devices are needed to maintain the even pressure needed for compression to work and it is unlikely that home-made interventions like the use of plasters or tape will help. Cryotherapy. Another therapy that has been recorded as working well is to have the keloid frozen (like you would a wart or skin tag). This often happens in combination with steroid injections or other keloid treatments as freezing only helps to physically remove the bump by killing off the cells and doesn’t treat the cause. Surgery. If injections alone don’t work (or your doctor doesn’t feel they will help) then the next step may be to have the bump surgically removed along with a course of steroid injections and / or compression therapy to lower the chance of any keloiding returning. Laser Therapy. The use of dye lasers instead of conventional surgery has also been used in keloid treatment. They work by ‘vaporising’ parts of the scar tissue, causing it to flatten. Colour or ‘pigment’ can also be reduced. Laser therapy is usually combined with steroid injections or another treatment to reduce the chances or recurrence.

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Further Reading

This guide was written with the help of several independent sources, mainly medical journals. If you would like to read more on the subject of keloids we recommend the following:


Asilian A, Darougheh A, Shariati F. 2006 .  New combination of triamcinolone, 5-Fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Dermatology Surgery. Jul;32(7):907-15 Available Fromhttp://www.ncbi.nlm.nih.gov/pubmed/16875473 Accessed On:14.08.12

Berman B, Bieley HC. 1996. Adjunct therapies to surgical management of keloids. PubMed.gov. Feb;22(2):126-30. Available From: http://www.ncbi.nlm.nih.gov/pubmed/8608373 Accessed On: 14.08.12

Shaffer JJ, Taylor SC, Cook-Bolden F. 2002. Keloidal scars: a review with a critical look at therapeutic options. Journal of American Academic Dermatology. Feb;46  63-97. Available From: http://www.ncbi.nlm.nih.gov/pubmed/11807470 Accessed On: 14.08.12

Gauglitz GG,  Korting HC, Pavicic T, Ruzicka T, Jeschke MG. 2011. Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies. MolMed.org. The Feinstein Institute for Medical Research. Jan-Feb. 1 7 ( 1 – 2 ) 1 1 3 – 1 2 5. Available From: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022978/ Accessed On:14.08.12

Parmod K Sharma, Dirk M Elston, et al. 2012.Scar Revision Treatment & Management. Medscape. Sept. 17th 2012. Available From: http://emedicine.medscape.com/article/1129913-treatment, Accessed On: 14.04.14 Peter B. Olaitan,  I-Ping Chen,  James E.C. Norris, et al. 2011. Inhibitory Activities of Omega-3 Fatty Acids and Traditional African Remedies on Keloid Fibroblasts. Wounds. Vol 22 (4), 97-106. Available From: http://www.woundsresearch.com/files/wounds/Olaitan_WOUNDS.pdf, Accessed On: 14.04.14. Kumutnart Chanprapaph, Somsak Tanrattanakorn, Penpun Wattanakrai, Pranee Wongkitisophon, and Vasanop Vachiramon. Effectiveness of Onion Extract Gel on Surgical Scars in Asians. Dermatology Research and Practice. 2012.Volume 2012, Article ID 212945. Available From: http://www.hindawi.com/journals/drp/2012/212945/, Accessed On: 14.04.14. Richard Baker, Fulvio Urso-Baiarda, Claire Linge, Adriaan Grobbelaar. Cutaneous Scarring: A Clinical Review. 2009. Dermatology Research and Practice. Volume 2009. Article ID 625376. Available From: http://www.hindawi.com/journals/drp/2009/625376/, Accessed On: 14.04.14. Dolores Wolfram, Alexander Tzankov, Petra, Pu’lzl, Hildegunde Piza-Katzer. Hypertrophic Scars and Keloids: FA Review of Their Pathophysiology, Risk Factors, and Therapeutic Management. 2009. Dermatological Surgery. 35.171–18. Available From: http://www.theaaams.com/wp-content/uploads/2011/12/Kelloids-rx.pdf, Accessed On: 15.04.14. Nader Pazyar, Amir Feily. Garlic in dermatology. 2011. Dermatology Reports. Vol 3, No 1. Available From: http://www.pagepress.org/journals/index.php/dr/article/view/dr.2011.e4/html, Accessed On: 15.04.14. Maha F. El Goweini,  Nagwa M. Nour El Din, et al. Effect of Quercetin on Excessive Dermal Scarring. 2005. Egyptian Dermatology Online Journal. Vol 1, 5 June. Available From: http://www.edoj.org.eg/vol001/00101/05/5.html, Accessed On: 18.04.14

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