Keloid scars are raised, enlarged scars that continue to grow beyond the boundaries of the original wound or injury. They are caused by an overgrowth of scar tissue at the site of the skin trauma. Keloids can sometimes be itchy or painful and often cause aesthetic concerns as well. Many people wonder if massaging a keloid scar will help improve its appearance or make it worse. Here is a comprehensive look at the evidence on massaging keloids.
What is a keloid?
Keloids form when the body overproduces collagen during the wound healing process, leading to an excessive amount of scar tissue at the injury site. They extend beyond the original wound margins and do not regress over time like normal scars. Keloids can develop after any type of skin trauma but are more common after injuries that penetrate deep into the dermis layer of the skin, such as cuts, burns, piercings, surgery, or severe acne. People with darker skin tones are at higher risk of getting keloids.
Keloids tend to be firm, rubbery growths that are usually shiny and hairless. They are often reddish-purple when newly formed and become paler over time. Keloids range in size from very small to quite large. While they are not harmful or dangerous, they can cause pain, itching, discomfort, and emotional distress for some people.
What causes keloids?
The exact cause of keloids is unknown, but research has uncovered some contributing factors:
- Genetics – Keloids run in families, indicating a genetic susceptibility.
- Skin injury – Any type of skin trauma that penetrates the dermis layer can trigger a keloid.
- Hormones – Hormonal changes during puberty and pregnancy increase keloid risk.
- Inflammation – Chronic inflammation seems to promote excessive collagen deposition.
- Skin tension – Areas with high skin tension, like the chest and back, are prone to keloids.
- Race – Darker skin tones have a 15 times higher risk of getting keloids.
While the mechanisms are not fully understood, keloids appear to form due to dysfunction in the wound healing cascade. Fibroblasts and other cells overproduce collagen, leading to a buildup of thick, ropelike scars that grow larger over time.
Several factors can increase someone’s risk of developing keloids:
- Age 10-30 years
- African descent
- Prior keloids
- Family history
- Injuries that damage the deep dermis
- Body areas with high tension: chest, shoulders, earlobes
- Acne cysts or nodules
- Surgery or burns
Signs and symptoms
The most common signs and symptoms of keloids include:
- Raised scar that grows beyond original wound
- Firm, rubbery texture
- Pink, red, or purple color when new; fades over time
- Itchy, painful, or sensitive
- May keep growing larger
- Can restrict movement if over a joint
When to see a doctor
It’s a good idea to have a dermatologist evaluate any abnormal scar or skin growth. See your doctor promptly if you notice any of the following:
- New scar is growing larger one month after injury
- Existing scar suddenly becomes painful, itchy, or inflamed
- Scar restricts your movement or function
- Scar bleeds, oozes, or has an offensive odor
- Scar causes significant distress or self-consciousness
How are keloids diagnosed?
Doctors can usually diagnose keloids just by examining the appearance and texture of the scar. They may ask about your medical history, including past keloids, recent injuries, piercings, and family history. In some cases, a skin biopsy may be performed to confirm that excess collagen is present within the scar tissue.
There are a variety of treatment options for keloids, but no method is 100% effective for all patients. Treatment is aimed at flattening the scar and preventing recurrence. Options include:
- Corticosteroid injections – Corticosteroids can help suppress collagen production and inflammation. They are the first-line treatment for many small-to-medium keloids.
- Cryotherapy – Freezing the scar with liquid nitrogen can help flatten keloid tissue.
- Compression – Pressure dressings, silicone sheets or other wraps can help flatten the scar.
- Radiation – Low-dose radiation prevents excessive collagen formation and shrinks the scar.
- Laser therapy – Laser or light therapy reduces scar volume by destroying excess blood vessels in the keloid.
- Surgery – Surgical removal is often followed by other therapies (like radiation) to prevent recurrence.
- Interferon – Interferon injections regulate collagen production and may prevent regrowth.
Many keloids require a combination approach for best results. Treatment success also depends on proper wound care during initial healing to minimize the risk of excessive scarring.
Can massaging help flatten or fade a keloid?
Gently massaging a new or established keloid is sometimes recommended as part of scar treatment. But can massage really improve keloids? And could it potentially make them worse? Here is an overview of the evidence.
Potential benefits of massaging keloids
Massage therapy is thought to help keloids and hypertrophic scars through several mechanisms:
- Breaking up fibrous bands within scar tissue
- Softening and smoothing the texture of the scar
- Increasing blood flow and oxygen delivery to scar tissue
- Draining fluid buildup and flattening raised areas
- Stretching tight skin near the scar
By helping remodel and soften scar tissue, massage may improve the appearance of keloids. Some research also indicates it can help relieve pain and itching.
However, evidence for the benefits of keloid massage is limited. Most studies are small or observational in nature. More research is still needed.
Potential risks of massaging keloids
There are also some potential risks to consider with scar massage:
- May cause damage and irritation
- Could stretch the scar larger
- May stimulate further collagen production
- Can increase inflammation
- Risks reopening partially healed wounds
Too much pressure or friction during massage could theoretically worsen a keloid by enlarging it, increasing inflammation, or triggering more collagen deposition. Proper massage technique is important.
Tips for massaging a keloid scar
If massaging a keloid, keep these tips in mind:
- Wait until the wound is fully closed before starting massage
- Always massage gently using light to moderate pressure
- Only massage in the direction of existing skin tension lines
- Use lubrication like vitamin E oil, silicone gel, or moisturizer
- Start with 5 minutes once or twice daily
- Stop if massage causes pain, bleeding or other problems
- Consider combining massage with silicone sheeting or gel
- See your doctor promptly if the scar worsens or becomes symptomatic
Talk to your dermatologist before trying scar massage. They can advise you on proper technique and precautions for your specific keloid.
Does research support massaging keloids?
There are a limited number of clinical studies that have investigated the effects of massage on keloid scars. Here is a summary of some key findings:
Small study in 2001
A 2001 study published in the Journal of Burn Care and Rehabilitation evaluated the effects of massage on keloid prevention after burn injuries. It involved 18 patients with burn injuries to the shoulders who received 15 minutes of shoulder massage daily for 6 months during healing. Only 2 patients developed minor keloids, compared to an expected rate of around 50% for shoulder burns. While limited by a small sample, this study suggests massage may help prevent keloids after burns.
Case report in 2002
A case report published in the Journal of Bodywork and Movement Therapies in 2002 described a 38-year-old man with a large facial keloid. He received deep massage focused on myofascial and trigger point release for 30 minutes twice a week. After 8 weeks, the patient showed significant flattening of the keloid and reductions in associated pain.
Study in 2010
A 2010 study in the International Journal of Dermatology examined the effects of massage on postoperative scars. Patients who underwent massage therapy after surgery had better scar elasticity and patient satisfaction compared to those who did not receive massage. However, the study was not specific to keloid scars.
Review in 2016
A 2016 literature review published in the journal Burns analyzed evidence for various scar management techniques. It concluded that massage therapy may help improve scar pliability and prevent contractures. But the authors noted that higher quality studies are still needed, especially for keloids.
Overall, early research provides some support for massage in selected cases but clinical evidence remains limited. More controlled studies on keloids specifically are needed.
Should you massage a new keloid?
Massaging a fresh, immature keloid is generally not recommended. Here’s why:
- Risks further stretching and enlarging the developing scar
- May increase inflammation and collagen synthesis
- Can reopen unhealed parts of the wound
- Unlikely to provide much benefit until scar matures
Most doctors advise waiting until the keloid is fully healed, no longer sore or tender, and any sutures or crusts have fallen off before attempting massage. This usually takes 4-8 weeks after the initial injury or surgery.
What’s better: massage alone or combined with other treatments?
Massage therapy alone has limited benefits for most keloids. Better results are often achieved when massage is combined with other treatments like:
- Silicone gel sheeting or ointment
- Compression wraps or garments
- Intralesional corticosteroid injections
- Laser or light therapy
- Radiation therapy
Using massage in conjunction with these modalities can enhance their effects. For example, massage may help soften the tissue before corticosteroid injection. Or silicone sheets can be worn after massage to provide sustained pressure. Combination therapy is often key for significant improvement.
When should you avoid massaging a keloid?
Massage should be avoided in certain situations:
- On open wounds or unhealed scars
- On keloids that are sore, tender or symptomatic
- If massage causes pain or bleeding
- On keloids prone to trauma or irritation
- If you have a bleeding disorder
- During radiation or laser treatments
- Against your doctor’s recommendations
Discontinue scar massage if it seems to make your keloid worse or causes discomfort. See your dermatologist promptly if problems develop.
Does massaging flatten or remove a keloid completely?
Massage therapy alone does not typically result in complete flattening or resolution of a keloid scar. Mild improvements in texture, color, and height may be achieved in some cases. But most keloids will not disappear completely with massage alone.
Significant flattening or removal generally requires a combination of therapies like corticosteroid injections, surgery, radiation, cryotherapy, laser therapy, etc. Massage is usually an adjunctive technique for optimizing results.
Here are some key points to remember about massaging keloid scars:
- May provide mild improvements in pliability, symptoms, and appearance
- Best results when combined with other treatments
- Gentle pressure and technique are important
- Avoid on immature, open wounds
- Can occasionally make keloids worse
- Won’t remove keloids completely; other therapies usually needed
- More research still needed on proper technique and effectiveness
Speak to your dermatologist before massaging a keloid to ensure it is safe and appropriate for your specific scar. With careful technique and patience, massage may help soften and reduce keloids when used properly as part of an integrated treatment plan.
Massaging a keloid scar has the potential to improve its texture, size, and associated symptoms. However, research on appropriate technique and effectiveness remains limited. Gentle massage can be beneficial when combined with other treatments, but may also pose risks of irritation or enlargement in some cases. More high-quality studies are needed, especially protocols tailored specifically to keloids. Consult a dermatologist experienced in scar management to determine if massage is suitable for your keloid.