Skin Color and Keloid – Is There A Relation?

Skin comes in a variety of colors, ranging from the darkest brown to nearly translucent ivory. Differences in skin color are caused by a variation in the type and amount of a pigment called melanin, a naturally-occurring substance that gives color to a person’s skin, eyes, and hair. 

Evidence suggests that how much or little melanin a person produces depends largely on their ethnicity. Typically, the most lightly pigmented skin types – usually found in people of European descent – have lower concentrations of epidermal melanin, whereas people with darkly pigmented skin (common in African and Indian skin types) can have twice as much epidermal melanin. 

Regardless of the amount of melanin a person produces, everyone develops scars when their skin is wounded or injured. Scars form when the deepest layer of the skin (dermis) becomes damaged due to a cut, scrape, burn, surgical incision, etc. When this happens, the body sends melanin and collagen-forming cells to the skin to form a new patch of fibrous tissue over the wound. This, in turn, closes the area and keeps bacteria and debris from seeping into the body.

Any time the skin is injured, there’s also an increased risk of forming a keloid – a prominent scar that develops into a thick and lumpy growth. Keloids form when the wound site produces too much collagen and melanin, causing the scar to grow uncontrollably until it reaches far beyond the edges of the original wound. Keloids are more common in people under 30 and individuals with darker skin colors. 

Skin Color and Scarring

According to the Fitzpatrick scale of skin phototypes, human skin can be classified into six different groups based on the amount of melanin found in a person’s skin cells. The lightest pigment is classified as Type I (ivory skin) and the darkest brown as Type VI. The first three skin phototypes have the lowest melanin concentration and are therefore the least likely to scar. 

Fitzpatrick skin Type IV (olive or caramel-toned skin) has a slightly higher risk for scarring than fairer skin tones, whereas the two darkest tones – Type V and Type VI – scar easily and carry a much higher risk for abnormal scarring (keloids, hypertrophic scars, post-inflammatory hyperpigmentation). 

Keloid Causes and Risk Factors

Researchers are still trying to figure out why some people are more likely to develop keloid scars than others. So far, we know that most keloids result from an overproduction of collagen in response to skin trauma. In addition, several factors seem to increase a person’s chance of getting a keloid after sustaining an injury to the skin, including:

• Age: more common in people between ages 10 to 30. 
• Genetics: around 25% of people who get keloids have a blood relative who gets keloids. 
• Skin type: having a darker skin tone (Fitzpatrick V or VI) raises the chances of developing a keloid.  
• Ethnicity: in the United States, people of East Asian, African, and Latin American descent carry a higher risk of forming keloids. 

Keloids tend to appear 3 to 12 months after an injury and can continue growing slowly over the course of months or even years. Initially, they may look bright red or pink, with ridged edges that extend beyond the original trauma area. Eventually, most keloids become darker than the surrounding skin, appearing as shiny and hairless lumps. 

Prevention

If you’ve ever developed a keloid following an injury, surgical incision, piercing, chickenpox scar, etc., you are more likely to get keloids in other places if you undergo skin trauma again. This is why people who are prone to or have a family history of keloids may want to consider avoiding tattoos, piercings, and elective cosmetic surgery or taking preventive measures to try and control potential keloid scarring. 

The American Academy of Dermatology Association makes the following recommendations to reduce your risk of developing keloids:

• If you’re going to pierce your ears, wear pressure earrings for at least 12-20 hours every day for 4 to 6 months.
• Try a test spot if you’re planning on getting a tattoo to assess your risk for scarring.
• If your skin is injured, wear silicone gel pads or pressure dressings as soon as the open wound heals.

Treatment For Keloids On Dark Skin Tones

For new or smaller keloids

Compression therapy: this treatment involves wrapping the healed wound with gauze and tape to restrict blood flow to the area. Pressure dressings must be worn for 16-23 hours a day every day for at least six months to successfully flatten keloids. 

Silicone gel sheets: a convenient home treatment, your doctor may recommend applying silicone-based patches that help flatten and reduce the size of the scar and discourage growth if your keloid is relatively new. 

Creams and ointments: skin moisturizers with onion extract and vitamin E can help reduce the appearance of new scars when combined with other approaches. 

Cryotherapy: This treatment involves applying liquid nitrogen at freezing temperatures to the keloid scar to flatten the area. It usually takes several treatments to obtain results. 

For older or larger keloids

Steroid injections: corticosteroid injections break collagen bonds and shrink small to medium keloids, causing them to flatten out. A typical treatment plan involves multiple injections administered every three to four weeks. 

Surgical excision: surgically removing a keloid scar can be a risky approach that provides temporary relief. Unfortunately, if the surgery is not combined with other techniques, most keloids return within a few months after excision, sometimes even more prominent than the original scar. 

Superficial radiation therapy (SRT): after the keloid has been surgically removed, applying localized radiation helps destroy keloid-forming cells to keep them from coming back. SRT after surgical excision can lower recurrence rates from 50-90% to 5-10%. 

Schedule a Consultation Today

Keloids are harmless to your health, but they can be quite bothersome and unsightly. If you are concerned about a keloid or an abnormal scar, the Keloid Plastic Surgery Center is here to help. Dr. Roberto Mendez and Dr. Gabriel Salloum have extensive experience treating both the simplest and the most complex and severe types of keloids. Call 1 (833) 4KELOID or 1 (305) 440-1798, or click here to schedule a consultation at the Keloid Plastic Surgery Center today.