Keloid (Parut Keloid): Punca, Rawatan & Cara Cegah

A keloid (parut keloid) is a raised scar that keeps growing until it is larger than the wound that caused it. Keloids often form after ear piercing, acne, surgery such as a caesarean, or a minor cut, and they are more common in people with darker skin, including Chinese and other Asian people. They are harmless and not cancerous, but they rarely fade on their own. Treatment such as steroid injections can help flatten them, although keloids often come back. This guide explains how to tell a keloid from a normal raised scar, what causes keloids, the treatment options and how to lower your risk.

Apa itu keloid (parut keloid)?

When skin heals after an injury, it forms scar tissue. The British Association of Dermatologists (BAD) explains that a keloid forms when the body makes too much collagen (the skin's structural protein) as it heals, so the scar overgrows and becomes larger than the original wound.

Some key facts from dermatologists:

• keloids are not contagious (BAD, American Academy of Dermatology);
• keloids do not turn into cancer (AAD). DermNet, a dermatology information website from New Zealand, notes that keloids are harmless, although people with keloids have a slightly higher risk of skin cancer than people without them;
• not everyone who gets a scar develops a keloid. BAD says only a minority of people do.

Keloid vs parut biasa: how to tell the difference

Not every thick scar is a keloid. A raised scar that stays within the wound is called a hypertrophic scar, and it behaves very differently. The NHS, AAD, BAD and DermNet describe the differences:

Doctors can usually tell the two apart by looking at the scar and asking when it appeared. If it is unclear, a small skin sample (biopsy) can be taken.

Other scars are different again. The NHS describes atrophic scars, which are sunken or look like small holes, usually after acne or chickenpox (see our guide to jerawat).

Tanda keloid: what it looks and feels like

According to AAD, BAD and DermNet, a keloid:

• is raised, firm and smooth, and often shiny and hairless. Some feel hard and rubbery, others soft and doughy;
• can be skin-coloured, pink, red, purplish or darker than the surrounding skin. It is often red or pink at first and may darken as it grows;
• usually starts as thickening skin at the site of an old wound. On an earlobe it may first look like a pimple;
• grows slowly, often for weeks or months, and sometimes for years;
• may feel itchy, tender, painful or burning while it is growing. This usually stops once it stops growing, but not always;
• can darken after time in the sun, and AAD says this darkening can be permanent.

Keloids vary in shape and size. AAD says a keloid on the earlobe often looks like a round, solid lump, while on the chest or shoulder it tends to spread across the skin. AAD says a keloid can range from the size of a pimple to larger than a football. Most people have only one or two.

AAD adds that a keloid over a joint can limit movement, and that having a noticeable keloid can affect self-esteem. Most people who seek treatment do so because they dislike how it looks.

Punca keloid: causes and who is at risk

AAD says anything that causes skin to scar can cause a keloid in someone who is keloid-prone. Common triggers include:

• ear and body piercing;
• acne or chickenpox (see our guide to cacar air);
• burns, cuts, scrapes and insect bites;
• surgery, injections and vaccinations;
• tattoos;
• skin infections and inflamed hair follicles (folliculitis). BAD says keloids are more likely after wounds that become infected (see our guide to bisul).

Rarely, a keloid appears without any obvious injury. This is called a spontaneous keloid.

Who is more likely to get keloids?

• People with darker skin. Keloids are more common in people of African, Asian or Hispanic descent (BAD). AAD says that in Asia, ethnic Chinese have the highest risk, and DermNet notes that Chinese people are more likely to develop keloids than people of Indian or Malaysian origin.
• Family history. AAD says about one-third of people with keloids have a parent, sibling or child who also gets them. BAD notes that the tendency can run in families.
• Age 10 to 30. AAD and BAD say keloids most often start between puberty and age 30, although they can appear at any age.
• Pregnancy. AAD says hormonal changes in pregnancy increase the risk, and BAD says keloids may appear or get bigger during pregnancy.
• Having had a keloid before. BAD says people who have had a keloid are more likely to get another if their skin is injured again.

Keloids are most common on the earlobes, chest, upper back, shoulders, upper arms and jawline. AAD says they rarely form on the palms, soles or genitals.

Keloid after ear piercing, a caesarean (parut czer) and acne

Ear piercing. The ear is one of the most common places for a keloid. AAD says that if you or a blood relative have had keloids, you may develop one after piercing any part of your ear. Watch a new piercing closely: if the earlobe starts to thicken, AAD advises removing the earring straight away and wearing a pressure earring instead, for at least 12 (ideally 20) hours a day for 4 to 6 months.

Caesarean scar (parut czer). AAD says a woman with keloid-prone skin can develop a keloid on her belly after a caesarean, a hysterectomy or other surgery in that area. If you have had keloids before, tell your surgeon before the operation, and see a doctor if the scar starts to thicken as it heals. For caring for the wound in the first weeks, see our guide to berpantang.

Acne and chickenpox. AAD says people are more likely to develop several keloids after acne or chickenpox, usually on the face, chest or back. BAD advises getting acne treated promptly to limit scarring.

Rawatan keloid (treatment)

BAD says there is no cure for keloids, but treatment can help flatten them and ease itching or pain. AAD says no one treatment works best for every keloid, and dermatologists often combine two or more treatments to get better results. The choice depends on where the keloid is, its size and depth, your age and how you responded to past treatment.

BAD lists other options, such as injections of 5-fluorouracil or botulinum toxin and photodynamic therapy, as experimental treatments that are not routinely available. Ask your doctor what is suitable for you.

Set realistic goals. AAD suggests thinking about what matters most to you before your appointment: easing itch or pain, flattening the keloid, or being able to wear earrings again. Keloids often grow back, so follow-up treatment and at-home care are important.

The NHS adds that if a scar is affecting your mental health, a doctor can refer you for talking therapy, and that skin camouflage creams and powders can help cover a scar.

Cara cegah keloid (prevention)

If you have keloid-prone skin, you cannot always prevent a keloid, but AAD says precautions may lower your risk or reduce its size:

• Avoid unnecessary skin injury. BAD advises people at higher risk to avoid tattoos, body piercing and unnecessary surgery or cosmetic procedures where possible, especially on the chest and earlobes.
• Test first. If you still want a tattoo or cosmetic procedure, AAD suggests starting with a small test area and watching for thickening skin.
• Tell your surgeon or dentist before any procedure if you or a blood relative get keloids.
• Care for wounds well. AAD advises washing even minor wounds with soap and water, keeping them moist with petroleum jelly gauze or a hydrogel dressing, and changing the dressing daily until healed.
• Use silicone sheets or gel once the wound has healed. AAD suggests using them every day for about 6 months.
• Protect the scar from the sun. AAD says sun can darken a scar. Cover it with clothing or use a broad-spectrum, water-resistant sunscreen of SPF 30 or more. The NHS advises keeping a new scar covered in the sun for at least a year.
• Act early. At the first sign of thickening, see a doctor. AAD says early pressure or treatment may stop thickening skin from becoming a keloid.

When to see a doctor

See a doctor at a klinik kesihatan or a GP, who can refer you to a dermatologist, if:

• a scar is growing beyond the original wound, or a new piercing or surgical scar starts to thicken;
• a scar is painful, itchy or bothering you (NHS);
• a keloid is bleeding or a wound on it is not healing (AAD);
• a scar is limiting movement;
• you are not sure whether a lump is a keloid. AAD notes that other conditions, such as an allergic reaction to earrings, can look like a keloid, and DermNet lists some skin growths that can look similar (see our guide to kanser kulit).

The NHS advises getting medical help urgently if a scar is swollen or painful, feels warm, or has pus coming out of it, as these can be signs of infection.

Frequently asked questions (FAQ)

Apa itu keloid (what is a keloid)?

A keloid is a raised scar that keeps growing until it is bigger than the wound that caused it. It forms when the body makes too much collagen while the skin heals. Keloids are usually firm, smooth and shiny, and can be pink, red or darker than the surrounding skin. They are not contagious and do not turn into cancer.

Apa beza keloid dan parut biasa (keloid vs hypertrophic scar)?

Both are raised scars. A hypertrophic scar stays within the edges of the original wound, usually appears within weeks and often flattens and fades over time. A keloid grows beyond the wound, can appear months or even a year or more after the injury, and usually does not fade without treatment.

Boleh ke keloid hilang sendiri (do keloids go away on their own)?

Usually not. The NHS and the American Academy of Dermatology say keloids do not usually flatten or fade without treatment. Once a keloid stops growing, it tends to stay the same size. Treatment can help flatten it and ease itch or pain.

Apa rawatan keloid yang terbaik (what is the best keloid treatment)?

No single treatment works best for every keloid. Steroid injections into the keloid are the most common treatment, and dermatologists often combine treatments, such as injections with surgery, pressure, silicone sheets, freezing (cryotherapy) or laser. Keloids often come back, so follow-up care matters.

Can I remove a keloid with surgery?

Surgery alone rarely works, because cutting out a keloid creates a new wound where a keloid can grow back, sometimes bigger. The American Academy of Dermatology says nearly all keloids return after surgery alone, so doctors usually add another treatment, such as steroid injections, pressure or silicone sheets, after surgery.

Can I prevent a keloid after a caesarean (parut czer) or ear piercing?

If you or a family member get keloids, tell your surgeon before an operation such as a caesarean, and watch the scar closely. If it starts to thicken, see a doctor early. Dermatologists suggest silicone gel sheets after the wound heals and protecting the scar from the sun. If you are keloid-prone, avoiding new piercings and tattoos is the best way to prevent new keloids.

Is a keloid dangerous?

Keloids are harmless and do not turn into skin cancer, but they can be itchy, painful or tender while growing, limit movement over a joint, and affect how you feel about your appearance. See a doctor if a scar is growing, painful, bleeding or not healing, or if you are not sure it is a keloid.

Disclaimer

This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. Health supplements are not intended to diagnose, treat, cure or prevent any disease.

References

• Scars — NHS
• Keloid scars: Overview — American Academy of Dermatology (AAD)
• Keloid scars: Signs and symptoms — American Academy of Dermatology (AAD)
• Keloid scars: Causes — American Academy of Dermatology (AAD)
• Keloid scars: Diagnosis and treatment — American Academy of Dermatology (AAD)
• Dermatologist tips to prevent keloid scars — American Academy of Dermatology (AAD)
• Keloids — British Association of Dermatologists (BAD)
• Keloid and hypertrophic scar — DermNet