DEAR DR. GOTT: A few years ago, when I was around 15, I noticed unusual red lumps appear on my upper back. I later consulted a dermatologist who informed me these were keloids.
Each of the keloids is about the size of a fingernail and I’ve now got about 10 of them on my back. I’ve been receiving cortisone injections for two years and while some have flattened a little, others seem completely unaffected. Each spot is still dark red. I’m terribly embarrassed of my back and won’t wear a proper bathing suit out of shame. After two years of most ineffective treatment, I feel frustrated and want to cry when I look in the mirror. I am also terrified that more keloids will develop.
I read your column often and hope you may have some suggestions about removal. Thank you.
DEAR READER: Keloids are caused by an excessive growth of scar tissue which forms at the site of a healed skin injury. It can result from acne, burns, vaccinations, surgical cuts, ear piercing, chicken pox, traumatic wounds, and more. They are most common in those of Hispanic, Asian and African descent and typically occur between the ages of 10 and 20.
Because you have 10 such lesions, I believe it is safe to say that you have a condition known as keloidosis which is a term used when many or repeat lesions occur. You don’t mention any injuries and because they are all confined to your back, I suspect they were caused by acne. This is further substantiated by the fact that they developed when you were around 15, a common time for teens to develop acne due to hormonal changes.
Keloids are usually red, pink or flesh-colored. They can be lumpy or ridged and are located over the site of a previous wound or injury. They are not usually dangerous but may be cosmetically unappealing. In some cases, the lesions may become less noticeable over time. Sun exposure during the first year after development may cause the keloid to become permanently tanned.
As a general rule treatment is not necessary. Surgical removal is not likely permanent and may result in a larger keloid appearing at the site. For those that are uncomfortable, cause irritation, etc., treatment with corticosteroid injections, cryotherapy (freezing), radiation, and laser treatments may be recommended. Unfortunately, these options typically only reduce the lesion in size rather than eliminating it.
Your dermatologist will be your best source of information; however, he has only offered corticosteroid injections for the past two years. With your less than optimal results, a new consideration should be considered. Speak with your dermatologist about it or request a referral to a plastic surgeon or another dermatologist for a second opinion regarding treatment.
Finally, because you are so emotionally affected by the lesions, I urge you to seek out a therapist to work through the issue. Keloids are difficult to treat and because you have many, you are more likely to develop more. They are nothing to be embarrassed of, but you must start the process of beginning to cope with the situation and to develop and accept an understanding that you will not only have to live with them for the rest of your life but could develop more. You can reduce the likelihood of this by taking care to avoid injuries whenever possible, but you MUST be able to cope with reality that keloids are a part of your life.
