Flat keloids refer to keloids that have not risen significantly above the skin level, and do not form keloid tumors or nodules in the skin. Cases of flat keloids are seen most commonly among Asians, light-colored individuals, and Europeans. Individuals with dark colored skin, Africans, and African-Americans can also have flat keloids.
We do not know what set of genetic factors result in a keloid to take on a flat form as opposed to becoming nodular. We can only assume that there must be a different and unique set of genes that drive different types of keloids. Unfortunately, research in this area has been extremely limited and none of these genes have ever been discovered. Flat keloids are often treated with intra-lesional injection of steroids or chemotherapy drugs. Response rates to these treatments vary. In a minority of patients, these keloids are very sensitive to steroid injections and may totally resolve after a few injections. In others, these keloids either do not respond to steroid injections, or have a short and temporary response, or may even be worsened by the injections.
Flat keloids often cause itching, pain, and local discomfort. These keloids can take on the form of a dumbbell or butterfly.
Surgery does not play any roles in the treatment of flat keloids. Instead, surgery will make these keloids worse. Patients will grow a much bigger keloid at the site of surgery.