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Keloid formation has been hypothesized to be the result of an abnormal or prolonged wound healing process, with persistent proliferation and extracellular matrix production of fibroblasts that should otherwise discontinue in normal wound healing.
While keloids that develop on some areas of the body of a woman for example, can be masked with clothing, those appearing on the back of the neck and especially on the earlobes, are very difficult to conceal. Presently, in treating keloids in general, although multiple treatment modalities exist, no single treatment has proven widely effective. Intra-lesional corticosteroid injections --- which help soften and reduce symptoms of pruritus and tenderness--- are believed to be by far the most common treatment option available at present, simply because they reduce inflammation and prevent the formation of abnormal collagen.
The complications of intralesional steroid use include, skin atrophy, hypo-or hyperpigmentation, and the development of telangiectasias.
Some experts believe surgical excision may be gratifying, providing an immediate cosmetic correction, but the problem here  however, is that surgical resection of keloids is contraindicated, due to the high rate of occurrence (meaning that the keloids reappear after surgery). This involves applying extremely low-temperature cryogens, such as liquid nitrogen, to the skin.
Based on finding, this treatment course which can last up to 4 months, involves the application of flexible adhesive sheets to a wound to increase the temperature as well as water and oxygen concentrations in the wound --- factors that allegedly promote healing. Based on finding, the most promising laser treatment results allegedly come from the use of the 585nm pulsed dye laser (PDL).

For now, it appears as if the greatest weapon against keloids is not only combination therapy, but also the closing of wounds with minimal tension, and patients education.
As a result, many women have to go around daily with these noticeable, and sometimes very ugly scars. With this approach, Triamcinolone acetonide, the most commonly used steroid, is injected directly into the keloid. Because patients typically require multiple needle sticks, especially for larger lesions, some authors suggest pre-treatment with topical lidocaine or the addition of lidocaine in the syringe to help get rid of injection-associated pain.
In fact, the excision often leads to a longer scar and the potential for a larger keloid in event of recurrence.
It’s believed to work by altering collagen synthesis and promoting normal wound healing. These sheets that are applied directly to the affected area, are believed to be most successful when worn for 12 to 24 hours.
Use of the pulsed dye laser in combination with intralesional steroid injection may also help soften the lesions and enhance the integration of steroid, according to experts.
Because patients with a previous keloid or a family history of keloids are at increased risk for developing abnormal scars, these individuals should be counseled against body piercing(such as ear piercing) and should avoid elective cosmetic procedures with a risk for scarring.

Not only can this mar the physical beauty of  these women, it can also affects them psychologically, in particular their self-images, and have a negative impact on their overall quality of life. Another negative finding is that Intralesional steroid injection may be impractical for very large or multiple keloids, since the pain of injection may be considerable. This method allegedly works best on smaller keloids, but is limited by considerable pain and sometimes prolonged healing after treatment.
Due to the uncertainty of the risk, some author recommend limiting its use to those who have failed previous excisional treatments, and to patients, age 21 or older.
Also, it has been said that the use of the laser as a monotherapy or in conjunction with intralesional triamcinolone injection has shown some promising results with a large percentage of patients remaining keloid-free at follow-up. Multiple injections at regular monthly intervals are generally required for larger keloids.
Because several treatments are often needed, the risk for hypopigmentation in darker-skinned patients is also a significant drawback.

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