Why Chest Keloids Feel Harder and More Painful

Hello. I am Dr. Lee Sang-ju, a dermatologist at the Skin Concern Counseling Center.

When the skin is injured, scars are bound to remain. However, when scars excessively proliferate beyond the scope of the injury due to one's constitution, it is called keloid. I have answered many questions about keloid scars, but today I will take the time to address key questions specifically about chest keloids.

If parents have keloids, there is a higher chance for their children to develop them, but it is not necessarily genetic, and there are many cases where keloids appear only in an individual even if neither parent has them. Of course, only keloids may appear.

It should be considered extremely rare for keloids to disappear naturally. Therefore, if a keloid appears, it is advisable to treat it actively in the early stages before it grows larger. It is a misconception to think that keloids will disappear naturally if left alone.

Generally, there is no known specific season when keloid symptoms particularly worsen or improve. However, when encountering many patients, some say that keloids grow slightly larger during seasonal changes, so there may be individual differences.

Keloid scars, which appear as red or white bumps on the skin, tend to occur in specific areas, and the chest is one of them. Chest keloids, in particular, become noticeable when wearing low-cut clothing or swimsuits as the weather gets warmer, leading many people to seek treatment around the beginning of summer.

The main causes of chest keloids are as follows:

• Acne: If the skin is injured by acne, and the wound heals by swelling unnaturally, chest keloids can form.
• Surgery for skin lesions such as sebaceous cysts: If there are lesions such as epidermal cysts or sebaceous cysts on the body, keloids often form in that area after surgery.
• Chest surgery: There are also quite a few cases where scars develop into keloids during the healing process after chest surgery.

Keloids commonly occur on areas such as the ears, shoulders, chest, and back. Among these, keloids on the chest are often harder and accompanied by more symptoms than keloids on other parts of the body.

In particular, keloids in the middle of the chest often have a shape that spreads sideways. This characteristic is named because its shape resembles a crab extending its legs.

Most chest keloids are caused by acne. Therefore, if chest acne and keloids are present together, it is effective to treat both simultaneously or to treat acne first. Acne can be compared to 'seeds', and it is important to treat the seeds first. If keloids are left untreated, pain or itching often worsens, and their size increases, so treating both simultaneously is most effective.

There are three main methods for treating chest keloids:

1. Surgical Treatment: This method removes chest keloid scars, but the recurrence rate after treatment is very high, and they often grow larger. Therefore, chest keloids are not treated with surgery alone. If surgery is performed, radiation therapy may also be combined, but radiation therapy is not widely performed in Korea due to the increased risk of cancer or ulcers after a long period.
2. Injection Treatment: Injections into the keloid area can reduce itching and pain. However, chest keloids are generally large, which can lead to significant pain and the disadvantage of requiring multiple treatments.
3. Laser Treatment: Laser treatment shows excellent effects in improving the height and color of keloids.

Since each treatment method has its advantages and disadvantages, combining various methods is more effective. In particular, combining injection treatment and laser treatment is reported to be the most effective.

Is there an injection treatment with less pain?

Keloid scars tend to be more painful the harder they are, and chest keloids are often harder than keloids in other areas. Therefore, some people experience significant pain when receiving injections for chest keloids. In such cases, pain can be minimized through a low-pain injection method that uses vibration around the keloid to disperse sensation. This can reduce pain to 10-30% of conventional injection pain, making it a treatment that even elementary school students can comfortably receive.

What should be done about residual redness after injection treatment?

Residual redness after injection treatment can gradually fade to a color similar to the surrounding skin by repeatedly treating it with lasers that target redness, such as Vbeam Prima.

What to do when itching symptoms appear?

If itching occurs after chest keloid treatment or in the keloid area, you should visit the hospital early for treatment. Early intervention makes treatment relatively easy. Therefore, if a new keloid forms, or if a treated keloid starts to grow larger again, it is advisable to visit the hospital quickly for treatment.

Can I do chest exercises?

Movements that stretch the skin may not be good for keloids. Therefore, it is advisable to avoid chest exercises during active treatment.

How to manage to prevent recurrence?

By sufficiently treating the keloid until even the small lumps, which are the 'seeds' of the keloid, completely subside and the color is removed, the recurrence rate can be lowered.

So far, we have learned about the characteristics of chest keloids and effective treatment methods. If you have any further questions, please contact us via the comments below or the Yonsei Star Dermatology KakaoTalk channel. Thank you.