Keloids are overgrowths of scar tissue that extend beyond the boundaries of the original wound. They can develop after skin trauma like acne, surgery, piercings, burns, and cuts. Keloids tend to be raised, reddish in color, and feel rubbery or firm. Many people wonder if keloids can pop or bleed since they resemble blisters or pimples. Understanding the structure and behavior of keloids can provide more insight into whether they are likely to rupture or ooze fluid when aggravated.
Can keloids pop?
Keloids form when collagen and other skin proteins are overproduced during wound healing. This leads to an excessive accumulation of scar tissue that projects outward from the skin’s surface. Structurally, keloids contain bundles of thick, ropelike collagen fibers surrounded by other skin components like blood vessels, fibroblasts, mucinous ground substance, and elastin fibers.
The sturdy, fibrous makeup of keloids means they are unable to spontaneously rupture or pop on their own. Keloids lack a fluid-filled cavity and a thin outer membrane like a pimple or blister. As a result, there is no accumulated pressure inside keloids that could cause them to burst open and drain when touched or squeezed.
While keloids typically do not pop, some factors can cause a keloid to appear damaged on the surface:
– Injury: Trauma from scratching, picking, shaving, clothing friction, or other impacts can erode or ulcerate the outer skin layer covering a keloid. This exposes the inner tissue, creating a wound that may ooze fluid and appear “popped.”
– Infection: Bacterial infection can develop in the skin overlying a keloid, leading to inflammation, pus formation, and breakdown of the surface. This can make a keloid look ruptured.
– Steroid injections: Cortisone injections are a common keloid treatment, but they can sometimes thin and damage the keloid’s skin covering. This may give the appearance of the keloid being popped open.
– Rapid growth: Very quickly expanding keloids may outpace their blood supply, causing the surface skin to become necrotic and slough off. This can expose the inner scar tissue and resemble a popped blister.
So while keloids themselves do not spontaneously pop, injury, infection, treatment side effects, or rapid growth can all contribute to a keloid appearing ulcerated, oozing, and opened on the surface. But this represents a secondary wound rather than the keloid actually bursting on its own like a pimple.
Can keloids bleed?
Keloids are well-vascularized with a dense network of small blood vessels running throughout the enlarged scar tissue. This vascular structure means that keloids can potentially bleed if the surface skin becomes damaged or eroded through injury, infection, overgrowth, or other trauma.
Some specific scenarios where a keloid may bleed include:
– Picking and scratching: Repeatedly manipulating or digging into a keloid can disrupt the skin and cause bleeding from the damaged blood vessels.
– Shaving: Razors and other hair removal techniques can create nicks and cuts on keloids that lead to bleeding.
– Clothing friction: Tight clothing rubbing persistently over a keloid can wear away the surface layers and expose bleeding tissue underneath.
– Medical procedures: Biopsies, cryotherapy, steroid injections, and surgeries on keloids carry risks of bleeding if blood vessels are punctured.
– Infection: Bacterial, fungal, or viral infections that affect a keloid can all precipitate bleeding from the inflamed scar.
– Ulceration: Ulcers that form on top of keloids often ooze fluid and blood from the eroded surface.
– Cancer: Though extremely rare, certain cancers like keloid sarcomas can develop in scar tissue and may bleed through the skin.
So while keloids themselves do not actively bleed, many external factors like injury, infection, irritation, and growth complications can lead to damage of the keloid surface and subsequent bleeding. This exposes the underlying vascular scar tissue. Proper wound care and protection of keloids from trauma can help prevent bleeding.
When to see a doctor
In most cases, minor bleeding from a keloid that stops on its own does not require emergency care. However, you should see your doctor promptly if:
– Bleeding does not stop after 10 minutes of firm, direct pressure on the wound.
– The wound is gaping open.
– You observe rapid enlargement of the keloid around the bleeding site.
– The amount of blood loss appears excessive.
– You develop symptoms like dizziness, fatigue, or paleness from blood loss.
– The wound shows signs of infection like pus, redness, warmth, or swelling.
– You have a bleeding disorder or use blood thinners that increase bleeding risk.
– You develop a fever over 101°F.
Seeking timely medical care is crucial for proper wound assessment, stopping the bleeding, minimizing the risk of infection, and monitoring for excessive blood loss. Your doctor can determine if stitches, antibiotic ointment, updated vaccinations, or other interventions are needed for the safe treatment of your wound.
Preventing keloids from popping and bleeding
You can help minimize injury and bleeding risk from your keloids by:
– Avoiding picking, scratching, or touching keloids unless cleansing wounds or applying medications.
– Using sun protection including broad spectrum sunscreen, protective clothing, and wide-brimmed hats to protect keloids. Sun damage can thin and ulcerate the skin.
– Wearing loose, soft clothing over keloid sites to prevent friction and shear injuries.
– Using electric razors or hair removal creams instead of blades on keloid-prone skin.
– Treating any infections early and fully to resolve inflammation and prevent wound breakdown.
– Seeing your dermatologist promptly if you notice any new growth, changes, or breakdown of keloids so treatment can begin early.
– Protecting keloids with silicone gel sheets, pads, or ointment which may help strengthen the skin barrier.
– Discussing keloid injections with your doctor to potentially shrink lesions so they protrude less and get less friction.
With vigilance and protective measures, many patients find their keloids remain intact without troublesome popping or bleeding episodes. But always see your doctor promptly for any keloid wounds, changes, or symptoms that cause concern.
Medical treatments for bleeding keloids
If you develop bleeding from a keloid that won’t stop, your doctor has various methods to achieve hemostasis and close the wound:
– Direct pressure: Using gauze or a clean cloth, your doctor will apply firm, direct pressure on the bleeding site for 10-20 minutes. This helps stop blood flow.
– Cauterization: Heat, electrical current, or chemical agents may be used to cauterize blood vessels and stop bleeding.
– Suturing: Stitches pulled tight over the wound can close the site to allow natural clotting. Absorbable sutures are commonly used.
– Steri-strips: These special adhesive strips can pull keloid wound edges together to enable clot formation.
– Hemostatic agents: Substances like collagen, cellulose, or thrombin externally applied can accelerate clot formation.
– Compression bandage: Tightly wrapping the wound with gauze or other material creates pressure to restrain bleeding.
– Topical thrombin: This protein can be applied to coagulate blood.
– Cauterizing agents: Silver nitrate sticks or electrical cautery devices burn and seal bleeding sites.
– Antifibrinolytics: Medications like tranexamic acid or aminocaproic acid help preserve clots.
– Blood transfusions: These may be administered for extensive blood loss to restore adequate circulatory volume.
Once bleeding stops, your doctor will provide wound care instructions. Bandages, antibiotic ointment, pain relievers, and wound cleansing may be part of at-home care as the injury heals. Avoid re-injuring the site. Follow up with your dermatologist to address the underlying keloid with steroid injections or other treatment. Addressing the keloid may help prevent future wounds.
Risk factors for keloids popping and bleeding
Certain factors can increase risk of keloids becoming damaged and bleeding:
– Genetic predisposition: Those with a family history of abundant keloid scarring are more prone to development of new keloids after skin injuries.
– Young age: Keloids are more common in those under 30 years old. The youthful skin has high collagen activity.
– Pregnancy: Hormonal changes and skin stretching during pregnancy can stimulate keloid growth and vulnerability.
– Highly pigmented skin: Darker skin tones, especially in those of African, Hispanic, or Asian descent, show higher rates of prolific keloid scarring.
– Severe acne: Widespread inflammatory acne leaving many residual scars provides abundant sites for keloids to form.
– Obesity: Excess weight stretches the skin and expands surface area vulnerable to friction and shear forces that can damage keloids.
– Smoking tobacco: Chemicals in smoke may interfere with normal wound healing and collagen regulation.
– Chronic diseases: Illnesses like diabetes, kidney disease, and hypertension hamper wound healing and may encourage keloids.
– Immune disorders: Conditions causing abnormalities in inflammation and immunity can contribute to excessive scarring.
– Nutrient deficiencies: Low vitamin C, vitamin D, zinc and other nutrients integral to wound healing can increase keloid risk.
Recognizing these risk factors can help motivate prevention and prompt treatment when keloids do occur to stop progression and secondary wounding. Multi-pronged approaches combining steroid shots, surgical excision, radiation, silicone, and other therapies are often used for significant keloids.
How to tell a keloid from a sebaceous cyst or wart
Keloids have some overlapping features with certain benign skin growths, in particular sebaceous cysts and warts. Recognizing distinguishing characteristics can clarify the nature of unusual lumps or lesions on the skin:
Keloids vs Sebaceous Cysts
| Keloid Characteristics | Sebaceous Cyst Characteristics |
|---|---|
| Develops after injury or trauma to skin | Develops spontaneously with no inciting injury |
| Grows beyond original wound boundaries | Remains confined to area of origin |
| Firm, rubbery texture | Soft, fluid-filled sac |
| Pink, red, or purple colored | Skin-colored, yellowish, or whitish |
| Fixated to the skin, immobile | Mobile, can sometimes be moved under the skin |
| Surface is usually smooth | Surface may open and drain fluid |
| Composed of dense scar tissue | Contains oily skin gland secretions |
Keloids vs Warts
| Keloid Characteristics | Wart Characteristics |
|---|---|
| develops after skin injury | Caused by HPV virus infection |
| Grows slowly over weeks-months | Rapid growth over days-weeks |
| Smooth, shiny surface | Rough, irregular surface with tiny blood vessels visible |
| Rubbery, firm texture | Fleshy, soft texture |
| Usually solitary lesion | Often occur in clusters |
| Composed of scar collagen | Caused by viral particles stimulating skin cell growth |
Careful visual inspection along with a skilled clinical exam allows doctors to distinguish keloids from other lumps and bumps on the skin. A biopsy may occasionally be needed for a definitive diagnosis. This guides appropriate treatment.
When keloids may require emergency care
Most keloids can be managed on an outpatient basis through scheduled doctor visits. However, seek emergency care promptly if you experience:
– Profuse bleeding from a keloid that persists despite 10+ minutes of direct pressure.
– Sudden, severe pain, swelling, or fever suggests a keloid may have become infected.
– You develop symptoms of anaphylaxis including hives, wheezing, tongue/throat swelling, and difficulty breathing after trying a new keloid treatment.
– A keloid rapidly enlarges over hours or days, which may impede breathing, swallowing, vision, or other critical functions based on its location.
– A keloid develops foul-smelling drainage, ulceration, or other signs of necrosis indicating serious wound infection.
– You experience trauma like a deep gouge, bite, or penetrating injury directly into a large facial keloid.
– A large, tense keloid suddenly deflates, shrinks in size and develops severe pain, which may indicate internal bleeding.
– You have multiple keloids that suddenly swell, become painful, and feel hot, which may reflect an autoimmune reaction.
While not common, occasionally a keloid may become infected, inflamed, or wounded in ways that require urgent evaluation to rule out risks like abscess, sepsis, or excessive blood loss. When in doubt, do not hesitate to be seen.
Home remedies to avoid on keloids
You may come across home or natural remedies for keloids using widely available ingredients like apples, onions, or toothpaste. However, these unproven methods are often unhelpful and may worsen scarring:
– Aloe vera: Its moisturizing and anti-inflammatory effects may temporarily soothe keloids but aloe vera cannot shrink or eliminate scar tissue.
– Honey: Honey may provide mild antibacterial effects but lacks evidence for flattening or removing keloids.
– Apple cider vinegar: This is an irritant. Acid solutions could inflame and damage sensitive keloid skin.
– Onion extract: Onion juice or paste may reduce scar redness somewhat but cannot inject keloids or alter scar composition.
– Lemon juice: Highly acidic lemon juice can disrupt and burn superficial skin layers, exacerbating scars.
– Toothpaste: Abrasive ingredients like baking soda may erode and ulcerate the thin keloid surface skin.
– Collagen supplements: Ingesting collagen does not direct more collagen formation to keloid regions. Topical collagen sheets may help.
– Coconut or vitamin E oil: No compelling evidence exists that these moisturizers reduce mature keloid scarring.
– Turmeric: Contains mild anti-inflammatory curcumin but this does not improve pathological keloid scar collagen.
– Garlic: May have antiseptic properties but placing crushed garlic directly on keloids could damage skin.
– Tea tree oil: This concentrated plant extract may irritate sensitive scar tissue.
Simple home remedies are unable to reverse the complex collagen abnormalities creating keloids. Evidence-based medical treatments should be discussed with your dermatologist. Some newer home devices like silicone patches, gel sheets, or laser combs may supplement in-office care.
Conclusion
Keloids are abnormal proliferations of scar tissue that exceed the borders of an original skin injury. They do not spontaneously rupture or drain fluid. However, keloids can become vulnerable to damage from friction, infection, and other trauma leading to weeping wounds, ulceration, and occasional bleeding. Prompt wound care and medical treatment are advised for any injured keloid. Preventative measures like sun protection, friction avoidance, and prompt treatment of existing keloids may decrease wounding risk. With proper management, most keloids can be maintained intact without episodes of popping or bleeding. Consulting a dermatologist knowledgeable in keloids allows for an individualized treatment plan and appropriate follow up.