Hello, and welcome to another deep-dive scientific review into one of the most misunderstood and misdiagnosed issues that the piercing industry faces: the Keloid.
Some piercings will experience some kind of lump or bump in their healing process- It’s the body’s natural first response to any snag, knock or mistreatment. Irritation to the piercing can come from many sources such as incorrect or low quality jewellery, pressure, snags, or incorrect aftercare. If you want to read about lumps, bumps and how to solve them click here. However a keloid is a medical issue and won’t go away on it’s own. This review simply goes into specifically what a keloid is, and how they can be treated and managed by a medical practitioner such as your GP or a dermatologist. Your piercer is not the person to ask for true keloid treatment.
The Keloid- A Clinical Diagnosis.
Keloids are large, firm, asymmetrical round lumps that will grow outside of the initial wound boundary. They are often slightly tender to the touch and will not go away on their own! Keloids do not stop growing, and do not shrink in size without medical treatment. Keloids, unfortunately, will often recur once surgically removed.
Keloids occur in all races, sexes and ages, but are most common in people between the ages of 20 and 30. Studies have shown that dark-skinned people usually of African descent are the most likely to get a keloid- 6-16% of these populations will experience a keloid in comparison to only 0.9% of White British people. This is not to say that you are guaranteed to get a keloid or are protected from them by your race!
Keloids are strongly linked to genetics- If you have a strong family history of keloid formation, you are much more likely to get keloids of your own.
Keloids – Why do they form?
Keloids don’t just appear, they grow as an overly powerful response to trauma to the skin.
If you look back to my previous review on the wound healing process, you will remember that the Maturation or Remodelling phase is the third and final phase of healing. Collagen is grown and the skin slowly softens and returns to its normal state. In keloid formation, collagen is synthesised at up to 20x the normal rate. This overproduction of collagen can be a cause of the fast-growing nature of a keloid. In addition to this, fibroblasts that produce the scaffolding on which new skin is developed are upregulated- Fibronectin (the scaffolding protein) is produced at a rate of up to 4x greater than in normal scar healing.
Growth factors are chemicals produced by immune cells within the healing tissue to promote wound repair. One in particular, TGF-beta, is really important for this process. In normal wound healing, this factor is carefully controlled and is turned off completely once the wound is healed. In keloid formation, TGF-beta is uncontrolled and is not turned off once the wound is healed and so is allowed to run riot within the tissue. In addition to this, the fibroblast cells found in keloids have many more receptors for TGF-beta and are therefore much more sensitive to it’s effects!
Keloids will not go away on their own- If your ‘keloid’ went away with better aftercare, then it wasn’t a keloid! Unfortunately keloids often require surgical intervention. If you remember, keloids are caused by overreaction to a wound, so surgery alone will often result in recurrence of the keloid. Surgical removal is often part of a multi-angle response including steroid injections, pressure plates upon the area, and sometimes even laser or radiotherapy. If you think you have a keloid, we highly recommend getting it checked out by a doctor or dermatologist.
One interesting treatment which has very recently emerged is the use of Interferon injections. Interferons (IFNs) are chemicals naturally secreted by cells within the human body in response to viral infections. One happy side effect they have is that certain IFNs such as IFN-α2b decrease the surrounding tissues ability to produce collagen, and directly block the binding of TGF-beta to the fibroblast receptors in order to prevent them from producing excess scarring! This treatment type could be used more commonly in the future.
So there you have it, a good overview of what a keloid is, why we get them, and what can be done about it. Again if you think you have a keloid, it’s important to get it checked out by both your trusted piercer and a doctor or dermatologist. We see a genuine keloid perhaps once a year, but the vast majority of lumps are not keloids at all! Most bumps we see are simply due to irritation of some kind and can be treated simply and easily with quality jewellery and gentle aftercare.
Berman B, Duncan MR. (1989) Short-term keloid treatment in vivo with human interferon alfa-2b results in a selective and persistent normalization of keloidal fibroblast collagen, glycosaminoglycan, and collagenase production in vitro. J. Am. Acad. Dermatol. 21:694–702
Gauglitz, G.G., Korting, H.C., Pavicic, T., Ruzicka, T. and Jeschke, M.G., 2011. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Molecular medicine, 17(1), pp.113-125.
Murray CJ, Pinnel SR. (1992) Keloids and excessive dermal scarring. In: Woundhealing, Biochemical and Clinical Aspects. Cohen IK, Diegelmann RF, Lindblad WJ (eds.). Saunders Elsevier, Philadelphia, pp. 500–9
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Wolfram, D., Tzankov, A., Pülzl, P. and PIZA‐KATZER, H.I.L.D.E.G.U.N.D.E., 2009. Hypertrophic scars and keloids—a review of their pathophysiology, risk factors, and therapeutic management. Dermatologic surgery, 35(2), pp.171-181.