Symptoms of keloids include itching, burning or pain at the site. A large proportion of keloids are not symptomatic. A severe keloid may rarely impair the range of motion of joints. The main complaint with keloids is that of the unaesthetic appearance which may occasionally prevent social interaction and trigger low moods and poor self-esteem. The patient may recall obvious preceding trauma to the site and enquiry must be made about other potential aetiologies including immunisations and recent infection.
There may be a family history of keloid formation.
The natural history may be helpful in diagnosis. Once established, there is often the classical report of slow but relentless growth over months to years. After a prolonged course, there is often a plateau in the rate of expansion. For mature keloids, there is often a story of multiple attempts at treatment with little, or only short-term, benefit.
The signs of a keloid scar are excessive growth of a scar which extends into tissue beyond the bounds of the original injury. It is elevated above the surrouding skin and frequently firm to hard in texture. The shape of a keloid may vary from round (typically on the earlobes) to rectangular; there may be claw-like outgrowths into the surrounding skin. Keloids may become pedunculated. In the early, active phase, the scar is often scarlet or bright red but with maturation, it becomes more pale. Typically, there are no surface hairs.
Keloids have a predilection for specific body sites such as the cheek, earlobes, presternal skin, upper chest including deltoids, and the upper limbs.
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