Unlike normal scars, keloids grow outside the original boundary of the cut or injury. Keloids do not happen with all wounds; high-risk areas include the earlobes, the middle chest and lower belly.
Scientists do not fully understand why or how keloid scars occur, though there appears to be a genetic component.
"It does tend to have a link with heredity," said Few. "If I have a patient who tells me that their mother, their aunt, their uncle all on one side of the family suffer with keloids, I take that very seriously."
When someone suffers a wound, cells within the skin called fibroblasts deposit connective tissue to hold the wound closed, creating a scar. With keloids, the fibroblasts continue to make tissue even after the wound is filled.
"Part of the problem with keloids is that somehow there is a lack of ability to shut down the normal healing or scarring process," said Brissett. "It's like the Eveready battery; it just keeps going and going and going until somehow it gets turned off."
Because the scientists do not know how to shut off the fibroblasts, most treatments have been at best only partially effective. For most currently available treatments, the recurrence rate is over 50 percent.
"It is a chronic disease; it's a disease that we are going to be dealing with for the rest of their lives," said Brissett.
Some patients try to flatten their keloids with liquid nitrogen, but the freezing process can discolor the skin. Removing the keloids with surgery, though tempting, often results in larger keloids.
Brown's keloid started as a small scar behind her ear, but after several surgeries the keloid spread to her entire ear.
Keloids are commonly described as a cosmetic burden; however, they also can be tender and itch. And for some patients, the scarring is so massive it can lead to disfigurement and debilitation.
Excess scarring can be minimized if treatment is begun soon after the keloid appears. But treatments can be burdensome. The steroid injections require visiting the doctor once a month, and moist dressings with silicone sheets to decrease itching and pain must be applied 12 hours a day. Mechanical compression dressings — used to reduce scar elevation and usually custom-made from stretchy fabric, shaped support bandages or adhesive plaster — must be worn over 23 hours a day to be effective.
"I probably get one or two patients a month that either write me, call me or e-mail me, and tell me that they probably won't be able to continue living if we cannot find something that can help them," said Brissett.
Which is not to say there is no hope.
According to Brown, who participated in a clinical trial for the topical cream Few developed at Northwestern, her situation has already improved drastically. The keloid on the top half of Brown's ear was removed and has not grown back. The keloid on the bottom half has shrunk and is no longer raised.
"I'm less self-conscious, and I recently started wearing my hair up," she said.
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