What is (And What Isn't) a Keloid

If you notice a bump forming on or around a new piercing, you have good reason to be concerned. As dainty as the earring may be, it is possible that your body views the piercing as an injury. Piercing growths (big or small) are never "normal," although they can occur often. Most people assume right away that their growth is a keloid, but the majority actually aren't. We spoke to dermatologists, Dr. Shari Sperling, and Dr. Jennifer MacGregor to learn exactly what keloids are and how to treat them.

What Is a Keloid?

A keloid is a type of raised scar that occurs when the skin has healed after a wound. According to Sperling, the scar appears thickened and sometimes pink or flesh-colored. Extra scar tissue grows after the injury, forming a smooth, hard raised area.

Keloids can range in size and can sometimes cause itching or tenderness. "Keloids are abnormal, inflamed scars that grow beyond the border of the original injury and continue to grow in thick lines, bumps, or even tumor-like nodules," says MacGregor. "Keloids can also develop after bug bites, acne, and other seemingly mild skin injuries. In rare cases, keloids develop spontaneously without recalled trauma."

What Causes Keloids?

"Keloids are associated with young adulthood and are (at least partly) hereditary. While the cause is not completely understood, there is evidence that several factors play a role in keloid development such as abnormal wound healing, abnormal blood vessel signaling, inflammation, deeper skin injuries, and mechanical stress," MacGregor continues.

Keloids grow because the body over-defends itself as a result of physical trauma, surgery, or injury to the skin. They are common for people under the age of 30. According to Sperling and MacGregor, African Americans are at an increased risk of getting keloids. It is best to avoid scarring to the skin by opting out of piercings, tattoos, elective surgeries, and some laser procedures. "Darker skin types are much more prone to keloid scarring and should make every effort to minimize unnecessary and preventable trauma to the skin," says MacGregor.

Can You Prevent Keloids?

If you are looking to prevent keloids from developing in the first place, MacGregor suggests looking into your family history or personal history of keloids, to prevent skin trauma or injury. If you are prone to keloids, piercings and tattoos are strongly discouraged. There's no real limit as to where keloids can form, as they can also grow on the tongue and other mucus membranes. If you decide to risk a tattoo or piercing, be aware that you may end up with excessive scarring and/or keloids.

Irritants like oil, sweat, dirt, perfume, hairspray and other things can aggravate a piercing and cause an infection. Unfortunately, it also won't respond very well to normal cleaning, (although it's important to keep it clean so it doesn't get worse). The upside to this kind of bump is that it's easily treatable at home by performing proper piercing aftercare. If it doesn't clear up in a few days, though, you should see your doctor.

"If one was to have a cosmetic concern on the face and it is not medically necessary to remove, someone with a history of keloids may opt not to do the procedure as a way to prevent the formation of a keloid," says Sperling.

How to Treat Keloids 

Treatments for keloids should be initiated at the first sign (before it becomes a hard rock or a lump). "Keloids are much easier to treat and keep at bay if in-office treatment is initiated right away at the first sign of scar thickening," MacGregor says.

Cortisone Injections

According to Sperling, "Cortisone injections done monthly of varying strengths can be used to help flatten them." In-office treatments injections with cortisone are adjusted depending on how thick or large the keloid is.

Sea Salt Soak

In general, to prevent any and all issues, you're going to want to listen to your piercer's instructions. Sea salt soaks, which any responsible piercer will tell you to do, are meant to draw out any pus and blood, which will release the pressure and aid healing. They also tend to be soothing.

It is recommended to cleanse the area twice a day with a piercer-recommended saline solution like H2Ocean ($15) and then use a non-scented, antimicrobial, dye-free soap like Naked Soap ($12). Sticking to that simple process will increase your chances of healing the infection without causing further irritation.

Silicone Gel/Sheets

Both Sperling and MacGregor agree that silicone is an important gel to use. "Place the silicone gel or sheets continuously (for 24 hours) to cover the scar and surrounding skin. Gentle massage also provides a mild benefit once the scar is healed," notes MacGregor. "Minimize movement pulling or stress to the area as physical compression wraps or garments can help reduce motion in mobile areas." The silicone sheets can be used on healed scars as well.

Laser Removal

Once a keloid occurs, vascular lasers can be used every three to four weeks. "Pulsed dye and long-pulsed Nd:YAG lasers reduce abnormal signals/stop the proliferation of keloidal fibroblast cells in hypertrophic (thickened) scars and keloids. Deep or thick nodules can be reduced with a combination of injections, vascular lasers, fractional resurfacing lasers, and laser-assisted delivery of 5-fluorouracil/corticosteroids," MacGregor explains. In severe or extreme cases, debulking surgeries or even radiation might be needed. "If the keloid is debulked with surgery, all of the above treatments are still needed on an ongoing basis so the keloid stays at bay or controlled." 

When You Should See a Doctor 

"At the first sign of thickening, firm bumps, redness, tender or raised areas within a scar—see a dermatologist or your surgeon. Do not delay treatment. Do not initiate treatment and fail to follow up (every six to eight weeks) to keep the scar as soft and flat as possible," MacGregor warns.

When the area around your piercing hurts, oozes pus, and/or bleeds, it's not a keloid; it's probably either an infection or a epidermal inclusion cyst. These cysts, while not malignant, will usually be little more than an annoyance and will sometimes go away on their own. Normally, they're painless, but they can rupture or get infected. They are easy for your doctor to diagnose, but they usually have to be removed surgically; or else the cyst may recur. If you think you have a epidermal inclusion cyst, the best thing for you to do is see your doctor and follow their recommendation—and despite all urges, don't touch it.

"If you have a history of keloids, you should make your provider know this prior to any skin procedures so that precautions can be taken to avoid keloid production," advises Sperling.

The Takeaway

Keloids are not preventable, but they are avoidable if you research your personal and family history. If you have a wound, take care of it immediately. Add ointment, non-sticking dressing, and protect your skin from the sun completely.

It is important to know the risks attached to a piercing or tattoo before scheduling as it can result in scarring. "Keloids can’t be ‘removed’ because new scar tissue wants to grow in the area constantly usually until it ‘burns out.' Eventually, it will slow down and stop growing but this can take years," MacGregor states. Some scars will remain and it is a personal choice whether you want to remove them or not. Be sure to seek a professional opinion on bumps and raised scars. The earlier, the better.