Keloids: Causes, Differences, and Modern Treatments

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

What is a keloid?

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

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

Does a keloid have a definitive cure?

It can be successfully treated and controlled, but there is no guaranteed definitive cure. The combination of surgery with beta-therapy achieves success rates above 90%, being the most effective treatment available.

Surgery alone has a high recurrence rate (up to 80%). Beta-therapy 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 limits of the original wound, invading healthy skin, while a hypertrophic scar remains confined to the injury 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 regress spontaneously. Microscopically, keloids have thick, disorganized collagen fibers.

What causes keloids on the ear?

Keloids on the ear are usually caused by piercings, otological surgeries, or trauma. The ear is one of the most common locations for keloids, especially on the earlobe. Genetic predisposition is the main factor.

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

How to avoid keloids after surgery?

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

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

Does corticosteroid work for keloids?

Yes, triamcinolone acetonide infiltration is one of the most widely used treatments. It reduces size, firmness, and symptoms such as itching and pain in 50-80% of cases. Generally, 3-6 monthly sessions are required.

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

Is beta-therapy for keloids safe?

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

A 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.