Consultant Plastic Surgeon Dr Somasundaram Sathappan from Soma Plastic Surgery

Dr Somasundaram Sathappan from Soma Plastic Surgery debunks common misconceptions about keloid scars

Injuries to the skin can cause scars. Some injuries heal well without visible scars, while others may develop disfiguring keloid scars. We speak to Consultant Plastic Surgeon, Dr Somasundaram Sathappan from Soma Plastic Surgery who explains the causes and treatments for keloid scars and puts some common myths to rest.

Myth 1: Keloid scars only affect darker skin tones

Dr Soma: While keloid scars are reported in up to 16% of darker-skinned individuals such as Africans and Hispanics, they can affect all skin types. In fact, keloid scars affect 0.15% of Taiwan’s mostly light-skinned Chinese population, according to a study by its National Health Insurance Research Database. Caucasians, in contrast, are the least affected.

Myth 2: Keloids scars don’t grow larger than their original wound

Dr Soma: This is not so; a keloid scar is fibroproliferative, which means it grows beyond the margins of the initial injury. In addition to skin type and genetic predisposition, it is also triggered by chronic skin infection where long-term inflammation increases fibroblast proliferation which synthesises collagen fibers during wound healing. This results in scars that are larger, stronger and thicker than normal ones.

Keloids vary in size, shape and colour depending on the patient’s skin type and the location of the wound. For example, keloid scars that occur on the ears after they are pierced tend to be shaped like dumb bells, while scars on the arm after a BCG shot (tuberculosis vaccine) tend to be thick, broad, and flat. I have even seen chicken pox scars so wide, they extend from one arm to the other.

Myth 3: Only certain skin injuries cause keloid scars. Keloid and hypertrophic scars are also the same thing

Dr Soma: A hypertrophic scar is a raised scar that does not spread to the surrounding tissues. Any sort of skin injury – scratches, cuts, burns, conditions such as acne or chicken pox, or piercings – can result in either a keloid or hypertrophic scar, as long as there is prolonged inflammation during the wound’s healing phase. Often confused with keloids, hypertrophic scars are also thick, but do not grow beyond the margins of the wound. They are also more likely to fade over time than keloid scars, which are usually permanent.

[Left] Patient in his 20s with keloid scar on his shoulder due to unknown cause. [Right] Patient with a normal scar after lipoma surgery. Photo courtesy of Dr Somasundaram Sathappan from Soma Plastic Surgery.

Myth 4: Keloids only affect certain areas of the body and show up immediately after the skin is injured

Dr Soma: Keloid scars can develop anywhere. However, they are normally found along the back, arms, neck, scalp and suprapubic regions – the region of the abdomen located below the navel – as these areas experience a lot of tension during wound healing.

Keloid scars do not show up immediately after the skin is injured either. In general, they take about a month to form. While there is no telling when a keloid stops growing, it will continue growing when accompanied by pain and itching, as this means the scar is active and therefore requires immediate treatment before it gets any larger.

Myth 5: Keloid scar treatments are simple, quick and always effective

Dr Soma: This is not true; keloid scars often recur, therefore requiring either aggressive or long-term solutions to resolve permanently. Before recommending any treatment, I first consider the patient’s age, the location of the scar, and the severity of the condition.

If a patient is an adult who wants immediate outcomes, I may suggest more aggressive treatments. Examples include patients with scars which have developed on the face, or scars which have contracted over the joints, resulting in functional disability.  If the patient is a child or has a scar that is less obvious and is not impeding his/her function, I may instead recommend slower, more conservative solutions.

Conservative treatments usually involve monthly steroid injections, daily silicone ointment therapy and steroid tapes. In general, steroid treatments deactivate and shrink keloid scars by 70% in four to six months. However, while most scars are incapacitated within months, others are more resistant to steroids, requiring repeated injections for up to two years. Once it stops growing, what is left of the growth can be safely excised, with some certainty it would not recur.

Aggressive treatments, in contrast, involve immediate surgical removal and is likely to require radiotherapy. As it is highly likely that a surgical scar will develop into a keloid scar in patients who have a history of keloid formation, I will ensure the cut is closed in layers with the objective of eliminating bacterial contamination, and reducing inflammation and skin tension during healing. If the scar is still active, I may also recommend radiotherapy for three to five days to reduce the risk of recurrence. While aggressive treatments offer faster results, they are much more expensive than conservative therapies.

Myth 6: Keloid scars are preventable

Dr Soma: Keloid scars cannot be prevented. However, active steps can be taken to avoid them such as:

  1. If the condition exists in your family, ask your paediatrician to administer injections via your baby’s or child’s buttocks rather than the arm during vaccinations. Wounds on the bum are less likely to turn into keloids.
  2. Share your condition with your doctor so he/she knows to take the necessary steps in avoiding keloid scar development when treating your wounds.
  3. Keep wounds clean and protected with regular dressings at home.
  4. Treat skin conditions such as acne and chicken pox early. The longer you wait, the more you enable the scars to form.
  5. Avoid tattoos, piercings or unnecessary body modifications/beauty treatments that result in slow healing wounds.


Featured photo by Dreamstime.
Dr Somasundaram Sathappan photo courtesy of Dr Somasundaram Sathappan.

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