Table 4.

Clinical Types of Keloids

Type of Keloid	Clinical Appearance	Anamnesis	Histology	Treatment
1. Fresh nodular keloid	Firm, growing, no confined borders, itching	Constant growth since months and years	Inflammatory cells, poor vascularity, fine collagen bundles, extracellular matrix	Excision with TAC or radiation—only, if recurrence!
a. Nodular earlobe keloid	Firm, fresh, or mature	Clear bacterial infection; often unilateral	Strong vascularity and broad collagen bundles	Excision, little risk of recurrence
2. Superficial spreading/“butterfly” keloid	Flat with central regression, telangiectasia	Endless growth at its edges over decades	Myxoid basis, strong vascularity, finger-like infiltration of dermis	TAC injections, only
3. Mature nodular and “burned-out” keloid	Soft, confined boarders, central regression, brain-like edges	“No-growth” Limited borders, regression since years	Packed hyalinized broad collagen bundles, few fibroblasts, few vessels, nodules of homogenized fibrils	Excision with TAC in back hand; “burned-out” have no risk of recurrence
4. Transition keloids	Multiple diverse keloids in different stages	Different onsets and types	All variations possible	Single excisions with TAC in back hand