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By Jose Pujalte Jr.

Jose Pujalte Jr.

Jose Pujalte Jr.

“The scars of others should teach us caution.”— Saint Jerome (374AD-419AD), Church Father and Patron Saint of Librarians Letter

As a surgeon, I leave scars on patients and it bothers me only if it bothers them. So when do scars become problematic or at least unacceptable to patients? When they turn into keloids.

Definition. The American Academy of Dermatology website defines keloids as “raised overgrowths of scar tissue that occur at the site of a skin injury.” “Injury” is significant because it’s clear that not only surgical cuts can be blamed. Other causes of keloids are: Acne, infections that leave scars like chicken pox, burns, tattoos and piercing, vaccination sites, traumatic wounds, and minor scratches. Keloidosis is the term used when many or repeated keloids appear.

Signs and Symptoms. This is a skin condition that is self-evident. But just the same, think of a keloid as a raised scar and this bump appears where (for example), the surgical cut is. It is also tough and darker in color than the rest of the skin around it. Sometimes it is lumpy or ridged. It can itch. It can be tender and uncomfortable.

Focus on Tattoos. One way of looking at a tattoo is that it’s ink under the skin and that alone makes it a risk in getting blood-borne diseases like HIV and hepatitis, skin infections, and of course, keloids. Red dye for tattooing has especially been identified to cause allergic reaction resulting in an itchy rash. Tattoo removal is difficult because it is meant to be permanent. But methods to remove them include laser surgery, dermabrasion and in small areas, surgical excision. For your protection, make sure that your tattoo artist has training, uses gloves, heat sterilizes all non-disposable equipment for use in tattoo making, and has fresh materials (new needles and dyes).

Treatment. Most keloids do not need treatment. Their size can be reduced by corticosteroid injections and external pressure. Removal, just like tattoos, is through laser treatments, radiation surgery and even cryotherapy (freezing).

Prevention. If you are prone to getting keloids, you may want to think twice about getting cosmetic surgery. But should surgery be necessary, the wound is immediately injected with corticosteroids or covered with silicone gel after the operation. Unfortunately, removing a keloid by excising it has a 45% recurrence rate. They just come back. The good news is that a keloid stops growing and remains stable until there is another injury.

It’s true we go through life getting scars along the way. But life is unfair so some get keloids instead.

Dr. Pujalte is an orthopedic surgeon. Email:

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