Face Keloid

Face Keloid

Keloid involvement of the face, obviously has a major impact on the person’s psyche and is a known cause for psychosocial anxiety.   This impact is real, even for those with mildest forms of facial keloids.  The impact is much greater in patients who have more noticeable and larger facial keloids. The impact is not only felt by person who has facial keloid, but also by others who come to see the keloid.

The patient who has a facial keloid may feel inadequate, or have low self-esteem.  The person who comes to see someone with facial keloids, on the other hand, may feel uncomfortable, or may feel bad for the victim of this disorder. And if this person is a hiring manager, he/she may think twice before hiring someone with noticeable facial keloids.

Facial keloids are equally seen among both genders and all races, but are more common among Africans, African Americans and Asians as opposed to Caucasians. Although facial keloids are seen in individual from all races and ethnic backgrounds, tumoral and massive facial keloids are almost exclusively seen among Africans/ African Americans, and often in those who have had prior keloid removal surgery.  Facial keloids among whites, and Asians does not evolve to become tumoral.  This is perhaps due to genetic differences that lead to the development of the disorder.

Great majority of patients who present with facial keloids also have keloids elsewhere in their body.   In men who have facial keloids, the lesions grow in size over time and involve wider areas of the skin.  Also, facial keloids may become infected and become a source of chronic purulent discharge.  Ingrown hair, either within the mass of keloids, or on the edges of facial keloids are common source of keloid infections.

Contrary to the belief, and practice of some plastic surgeons, facial keloid should never be removed surgically. Surgery is often contemplated in management of primary nodular keloids in African Americans. Surgery often results in worsening of these keloids and should be avoided at all cost.  Medical treatment of secondary facial keloids can become quite complicated and rather challenging after prior attempts at surgical removal.

There are clear differences in the manner that facial keloids present, not only by way of appearance of the keloids, but also among people with white or black skin.

Post-Traumatic Facial Keloids are triggered by a prior serious injury to the skin, such a surgical procedure, or a skin biopsy, or deep wound in individuals who harbor a very mild form of the disorder.  Quite often these individuals do not have any other keloids elsewhere in their skin, and previously have had no issues, or very minimal problems with wound healing.  Men or women who develop a keloid at the sites of skin biopsy, or a face-lift surgery are among this group.

Face keloid in a young Caucasian female.

Face keloid in a young Caucasian female. This keloid formed at the site of a prior minor facial surgery that was performed to remove a benign skin lesion.

Facial Keloid

Recurrent facial keloid after surgical removal of a primary facial keloid in a young African female with no other keloid lesions elsewhere. This young patient had a direct trauma that resulted in a laceration on her face, which was sutured. The wound soon evolved into a keloid, which was then removed surgically. Dense keloid tissue started forming soon after the surgery.

Facial Keloid

Keloid formation over the longitudinal scar of surgery. This patient had previously sustained an injury to his face that caused formation of a primary keloid which was subsequently removed surgically. Secondary keloid formed along the line of prior keloid surgery. Notice keloid tumor formation on both ends of his keloid. This patient also has heavy scaring over another surgical wound on his trunk.

Papular/Linear Keloids of White Skin:

These keloid often develop at a younger age, often in teenagers and among Asians or Caucasians. These keloids are often triggered by acne. Most these patients have other keloid lesions elsewhere on their skin. Some of these patients suffer from mild form of the disorder, and over time develop only few keloid papules, or nodules, on their face as well as their chest, shoulders or upper arms. Some others have more severe form of the disorder and develop numerous skin lesions over time. Although the genetics of keloid disorder remains unknown, it is quite plausible to hypothesize that the genetics of the disorder is quite variable among different ethnic groups, and always more severe among Africans/African Americans and those with black skin.

Facial keloids in white skin individual

Papular/Linear Keloids of White Skin.

Linear Facial Keloids

Linear and papular facial keloids in a young Asian male.

Nodular keloids, left side of the face

Nodular keloids, left side of the face in a young Asian patient.

Facial Keloid Patch

Over time, small keloid lesions can merge and create large patches of keloids. This process is often expedited by ill advised surgery,

Multiple primary papular / nodular facial keloids

Multiple primary papular / nodular facial keloids in a young African American male.

Tumoral Keloid of Face

Large tumoral keloid of face in a young African American Female.

Recurrent keloid after surgical removal

Recurrent face keloid after surgical removal of prior keloid just 10 month later.

Recurrent face keloid after surgical removal.

Recurrent and worsening of face keloid after surgical removal of prior keloid.

Worse outcome after surgery

Worse outcome after surgery in a middle aged patient with multiple other keloids. Notice the crust over a constantly draining fistula from a chronically infected site in this keloid.

Severe Face Keloid due to surgery

Diffuse facial keloids in a young African American, recurrence after two prior surgeries with worse outcome than ever before.

Although the genetics of keloid disorder remains unknown, it is quite plausible to hypothesize that the genetics of the disorder is quite variable among different ethnic groups, and always more severe among Africans/African Americans and those with black skin.

Treatments of facial keloids:

Treatments of facial keloids have to be planned very carefully. General principles of keloid treatment apply to facial keloids as well. With very high rate of recurrence and risk of worsening of keloids after surgery, all facial keloids have to be treated medically.  Surgery and radiation therapy should be avoided in all patients.

Treating facial keloids, much like other keloids, can be challenging and time consuming. Patience and perseverance are the two most important factors in achieving successful treatment results. Treatment of facial keloids has two phases:

Phase 1: Remission induction or debulking the keloid tissue.

Phase 2: Maintenance treatment.

With a proper treatment plan, one has to first reduce the mass and bulk of the keloid tissue. This step will require several rounds of non-surgical treatments, often with cryotherapy. Once the keloids are made flat, an on going evaluation and maintenance plan will address any possible recurrence and/or new keloid spots that form.