Keloids: Causes, Differences, and Modern Treatments

Keloids are scars that grow beyond the original wound. The combination of surgery with betatherapy achieves success rates above 90%. Below, the main questions answered by Dr. Fernando Amato.

What is a keloid?

A keloid is an abnormal scar that grows beyond the boundaries of the original wound. It is caused by an excessive production of collagen during healing, forming a raised, firm, and often reddish or dark tissue.

Unlike a hypertrophic scar (which remains restricted to the lesion area), a keloid invades the healthy tissue around it. It can cause itching, pain, and cosmetic discomfort. They are more common on ears, shoulders, chest, and pubic area. People with darker skin (phototypes IV-VI) and a family history have a higher risk.

Do keloids have a definitive cure?

They can be successfully treated and controlled, but there is no guaranteed definitive cure. The combination of surgery with betatherapy achieves success rates above 90%, making it the most effective treatment available.

Surgery alone has a high recurrence rate (up to 80%). Betatherapy applied within the first 24-48 hours after surgical excision reduces recurrence to less than 10%. Other complementary options: corticosteroid infiltration (triamcinolone), cryotherapy, silicone sheets, and pulsed dye laser.

What is the difference between a keloid and a hypertrophic scar?

A keloid grows beyond the boundaries of the original wound, invading healthy skin, while a hypertrophic scar remains restricted to the lesion area. Hypertrophic scars tend to improve over time; keloids can continue to grow.

Hypertrophic scars appear in 4-8 weeks and regress in 1-2 years. They respond well to silicone and corticosteroids. Keloids can appear months later and do not spontaneously regress. Microscopically, keloids have thick, disorganized collagen fibers.

What causes keloids on the ear?

Ear keloids are generally caused by piercings, otological surgeries, or trauma. The ear is one of the most common locations for keloids, especially in the lobe. Genetic predisposition is the main factor.

The earlobe is particularly susceptible due to its poor vascularization and constant traction. Treatment includes surgical excision with betatherapy, corticosteroid infiltration, and compressive earrings post-operatively. Success rate exceeds 90%.

How to prevent keloids after surgery?

Use silicone tapes for 3-6 months, avoid tension on the scar, protect it from the sun with SPF 50+, and discuss your history with your surgeon. Patients with a predisposition may benefit from preventive betatherapy.

Essential measures: layered surgical closure to reduce tension, intradermal sutures, silicone tapes starting from 2 weeks, strict sun protection, and avoiding activities that pull on the scar. For high-risk individuals, prophylactic betatherapy may be indicated.

Do corticosteroids work for keloids?

Yes, infiltration of triamcinolone acetonide is one of the most used treatments. It reduces size, stiffness, and symptoms like itching and pain in 50-80% of cases. Typically, 3-6 monthly sessions are needed.

Intralesional corticosteroids inhibit excessive collagen production and reduce inflammation. Possible side effects: skin atrophy, hypopigmentation, and telangiectasias. Frequently used as an adjuvant treatment after surgery or as a first-line treatment for smaller keloids.

Is betatherapy for keloids safe?

Yes, it is considered safe when performed by a specialized team. It uses low doses of radiation that only reach superficial skin layers, without systemic effects. It is the method with the highest success rate.

Strontium-90 applicator emits low-penetration beta radiation (a few millimeters), applied within the first 24-48 hours after excision, in 3-4 sessions. It is not associated with an increased risk of cancer. Contraindicated in pregnant women and young children.