The lesions pictured here are typical of the disfiguring changes that sometimes occur after trauma to the skin. In children, a laceration, a surgical procedure, or a bout of chicken pox may be the inciting event for keloid formation. Figure 17-36 shows a keloid that was caused by ear piercing. Keloid formation is more common in African American children, is very rare in infants, and becomes somewhat more frequent with increasing age. Keloids begin as firm, telangiectatic plaques confined to the site of the initial wound. Over time, they become less erythematous and extend beyond the site of injury. Pruritus, burning, and hyperesthesia are frequent complaints. In contrast to hypertrophic scars, keloids extend beyond the limits of the original scar and do not resolve spontaneously. In fact, they may continue to grow over a period of years. The monthly intralesional injection of corticosteroids is currently the preferred treatment for most keloids; however, newer treatment modalities such as silicon gels or sheets, retinoic acid, imiquimod, and others have been shown to have some efficacy. Surgical excision will almost always result in recurrence but is somewhat more successful when accompanied by the injection of corticosteroids.