DRHOOK- Scarred for life: Itchy, ugly keloids can ruin surgery

the handsome doctor John Hong of Charlottesville

"I'm scarred for life." Not "scared" as in, "Run, Forrest, Run," but as in, "You hurt me. You hurt me bad!"

Scars never really go away. They can diminish, but a scar is a scar: Al Pacino, Scarface– Batman's Two Face– Joan Rivers—Oh, wait, those are multiple face lifts. 

 Remember in Lethal Weapon (I don't remember if it was I, II, or XX) when the two cops were comparing scars from gunshot wounds to knife stabbings? Some people just have to outdo others.

 But what happens when a scar goes way out of control?

 Keloids come from the Greek meaning "tumor like." Indeed, these bulging keloids come from excess tissue in scars. They are benign fibrous growths that extend beyond the margins of the scar (versus a hypertrophic scar, which is a thick scar staying within the borders of the scar). 

 So keloids stick out like a sore thumb, and indeed can even hurt like a sore thumb. Itchy, tender, painful– a keloid can be much more than a cosmetic issue. 

 Keloids occur mostly on ears, neck, chest, shoulders, and upper back for some reason. In particular, African Americans are most susceptible to keloids, and there appears to be a family tendency to develop keloids. 

 I remember seeing Belinda Carlisle of the Go Gos with a bunch of piercings in her ear back in the ‘80s and I thought, "Ouch!" For those who get keloids, just getting one piercing in the ear can turn the earlobe into an ear globe: enlarged protruding scar tissue that can be discolored. 

I've never heard of these things: Zimmer Splints— they're pressure earrings applied after getting one's ears pierced. They might help prevent a keloid from popping up.

 Acne keloidalis nuchae are pustules on the back of the neck from inflamed hair follicles that become keloids. To reduce the pain-in-the-neck lesions, shaving the neck should be eliminated, and the hair in the back of the neck cut no shorter than 1/8" with scissors.

 Many patients want little benign moles removed for cosmetic reasons, but for a person who gets keloids, that's like replacing a subcompact car with a van. Not going under the knife at all is the best advice to prevent keloids.

 In the Star Trek episode in which Ohura and Kirk are forced to get kinky, the aliens with special powers would die if they got cut. For folks who get keloids, every scrape and cut is a major bummer. 

Everyone should tend to his/her wounds, and in folks with keloids, it goes double. Keeping it clean, using petroleum-based topical antibiotics, and covering it (such as with nonadherent dressings like Telfa) to keep it moist might help the early healing phase to reduce keloids. Silicon gel sheeting might prevent or reduce keloids.

 Everyone swears by aloe vera, but it makes my eczema worse. Aloe vera, the antifungal component in some topical antibiotics, and vitamin E oil might all cause a skin reaction to make keloids Jiffy Popcorn up. Sun exposure to a new wound can also cause discoloration.

 Removal of keloids is pretty successful, but they tend to recur in the same spot (on average 50 percent of the time). Injecting corticosteroids into keloids is popular, as well as freezing them down. Radiation treatment, interferon alpha injections, and 5-FU injections all have risks. 

Seems like everyone has to have a Laser or they aren't cool. Pulse-dye laser therapy combined with steroid injections might be pretty successful. Surgical excision followed by steroid injections is a last resort. 

 No one likes getting cut, and to have a keloid to remind you of it for the rest of your life stinks. Hopefully better treatments will develop to prevent keloids from coming back. Maybe the technique will be called escargot.


Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice and an interesting website, drjohnhong.com. Email him with your questions.