Involvement of scalp as the only site of keloid disorder is very uncommon. About two-thirds of patients have keloid lesions elsewhere on their skin. Like other keloids, the clinical presentation, size, and shape of skin lesions of scalp vary from patient to patient. Scalp keloids are highly gender and race specific, seen almost exclusively in African/Afircan Ameriacn men.  Scalp keloids among women is very uncommon, and seen only in African/African American women who suffer from very adnaced forms of keloid disorder. 

Scalp keloid lesions in their early stages appear as small, raised spots; and are few in number. As time passes, the lesions grow in size and in number and spread to involve a larger area of the scalp.

Keloid involvement of scalp has three distinct patterns:

1. Occipital keloids with acne keloidalis as a major component, presenting with small bumps (keloid papules) in occipital area and upper neck.
2. Keloid involvement of scalp without acne keloidalis component leading to formation of typical keloid nodules and tumors that are also seen elsewhere on the skin.
3. Massive scalp keloids that only seen among those who have had prior scalp keloid removal surgery.

Treatment of scalp area keloids must be planned very carefully to accommodate the type, size, and location of keloid lesions. General principles of keloid treatment apply to these keloids as well. Surgery quite often results in worsening of these keloids and should be avoided in all patients. Radiation therapy should also be avoided, as it exposes the patients to the risk for development of cancer.

All scalp keloids should be treated with medical means only. Most patients will require protracted course of treatment which will incorporate topical cryotherapy for bulky lesions, topical steroid lotions for very small and papular lesions, and rarely steroid or chemotherapy injections into the keloid lesions.