My son recently had a small operation which left a scar that has healed oddly. Our doctor says it has become keloid. Can you tell me anything more about it? Caroline

A keloid is a scar that doesn't know when to stop. When the skin is injured, cells grow back to fill in the gap. Somehow, they 'know' when the scar tissue is even with the contour of the skin, at which point they stop multiplying. When the cells keep on reproducing, the result can become a keloid scar. When a scar becomes keloid it may extend beyond the site of injury and will not subside.

People of African or Asian descent are more likely to get keloids than people with lighter skin. (In this respect, keloids are exactly the opposite of most skin cancers which tend to occur in light-skinned people.)

Keloids can occur anywhere on the body but are most likely to appear on the ear lobes, neck, chest, or back, and usually occur after an injury or surgery. Occasionally they occur spontaneously, especially on the mid-chest area. Keloids often follow inflammation caused by acne on the face, chest, and back.

Keloids may be painful both physically and emotionally (from a cosmetic perspective), but it's important to address keloids primarily as a medical, rather than cosmetic condition.

At present there are no acceptable solutions for removing keloid scarring. Surgery is not advisable as you may end up with an even larger keloid than you previously had.

Cryosurgery which involves freezing the keloid with liquid nitrogen may flatten it, although this method can also produce discoloration of the skin.

Silicone sheeting appears to minimise some keloids if used regularly over several months. Silicone sheets are available without prescription from most chemists.

Long-term compression of keloids with pressure bandages can help soften them but this does require perseverance.

The most common treatment method is a series of cortisone injections but there can be side-effects such as a 'cortisone flare,' a condition where the injected cortisone crystallizes and can cause a brief period of pain worse than before the shot. This usually lasts a day or two and is best treated by icing the injected area. Another common side-effect is whitening of the skin where the injection is given and should be of concern to people with darker skin.

Some doctors cut the keloids out and inject the healing site with cortisone to help prevent recurrences. Whilst others may opt to use laser surgery which will help lessen the redness but will do nothing to the bulk of the keloid.

If you know that you have skin that is prone to keloid scarring then where ever possible avoid elective surgery, tatooing or body piercing.

The best advice is to learn to live with your keloid if you can. They cannot be prevented and it is just down to luck as to whether one will form from a scar.

Remember a scar is a permanent reminder of something that you have come through, if you can see it as a positive experience it will be easier to live with.

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