Keloids are firm, red to violaceous, large, tender nodules. They are usually hyperpigmented in African Americans and red to purple in Caucasians. Depending on the type of original injury, the lesion may be linear or nodular. By definition, keloid scars extend beyond the area of trauma or injury, and may continue to grow to enormous sizes. Earlobes are a common site of keloid formation. Keloids occur in this area most often after piercing.
These lesions are very firm, smooth, pink to violaceous nodules that can be tender, and continue to grow well after the piercing. Attempts to remove these lesions by any means often fail. Any area on the body can develop a keloid, but one is far more likely to develop a keloid on the upper trunk, head and neck. Keloids can be relatively flat and broad, or elevated several centimeters depending on the type of trauma and area it covers.
In rare instances, keloids may arise, spontaneously, without preceding trauma. This usually occurs on the chest and shoulders. A skin biopsy is usually not needed to make the diagnosis. Keloid scars show no tendency toward regression and tend to enlarge over time.