Simple scratch but serious scar

This young boy fell off his bike into a wire fence and was scratched lightly on his neck. Nothing needed stitching but over several months these large keloid scars developed in the damaged areas. Some individuals have a predilection for developing keloids, and only in certain body areas, particularly above the nipple line. Keloids are made up of thick collagen bundles extending beyond the original scar line and they also have many mast cells, explaining why they itch. They can be treated using intralesional Kenacort-A 10 at six weekly intervals until flattened but the skin discolouration tends to remain. Attempted re-excision usually just leads to a larger recurrence.