Keloid Nomenclature

KRF has always advocated for precise terminology, addressing the ongoing lack of clarity in the literature when the term keloid is used in isolation. As currently applied, the term often fails to distinguish whether it refers to the underlying disease process or to the visible skin lesion itself.

Given the wide clinical spectrum of keloid disorder (KD), the use of accurate and consistent terminology is essential—both in scientific publications and in communication among healthcare professionals—to ensure clarity and improve patient care.

To address this long-standing ambiguity, KRF has formally adopted the following standardized terminology framework for the precise description of patients, the disease entity, and keloidal skin lesions. This guidance aims to promote clarity, improve communication among clinicians and researchers, and facilitate comparability of data across studies.

• Keloid Disorder (KD): This term should be used exclusively to refer to the disease entity, regardless of its clinical presentation or extent.
• Keloid Patient: This term should be used exclusively to refer to the patient who has KD.
• Keloidal Lesion: Refers to any cutaneous lesion attributable to keloid disorder (KD).

To further improve diagnostic accuracy and communication, the following lesion-specific terms shall be used to define keloidal lesions:

• Keloidal Papule: A small, solid, raised lesion measuring less than 1 cm in diameter.
• Keloidal Nodule: A firm, raised lesion measuring 1–2 cm in diameter.
• Keloidal Tumor: A large, solid, raised lesion measuring greater than 2 cm in diameter.
• Keloidal Plaque: A broad, flat-topped, elevated lesion measuring greater than 1 cm in diameter.

KRF strongly advises against the use of the term "keloid" as a standalone descriptor, emphasizing the importance of adopting the standardized terminology outlined above to promote greater clarity and consistency in both clinical and academic settings. The only acceptable exception to this guideline is when "keloid" is used as part of a more specific term or phrase—such as "ear keloid," "chest keloid," “infected keloid” or "surgical removal of a keloid"—where the context clearly defines the anatomical site or the nature of the intervention for a keloidal lesion.

Furthermore, KRF strongly advises against the use of the term “keloid scar.” This terminology is both inaccurate and misleading. Keloid Disorder (KD) and keloidal lesions are not scars, and referring to them as such minimizes the clinical significance and complexity of the disease. The use of the word scar in this context contributes to confusion among healthcare providers and payers, and often leads to the misclassification of KD as a purely cosmetic issue. As a result, insurance companies frequently deny coverage for medically necessary treatments, viewing them as elective procedures intended for scar revision. This mislabeling has a direct and detrimental impact on patient care and access to appropriate therapy for this debilitating condition.

Lastly, the term “hypertrophic scar” is deemed inaccurate by KRF, as it does not accurately reflect the underlying disease process. A helpful analogy is the term acne scar—which refers not to active pustular acne but rather to the long-term atrophic changes that develop at sites of prior inflammation. Similarly, the term hypertrophic scar implies a post-inflammatory or post-injury outcome, rather than an active pathological process. This mischaracterization can lead to clinical misinterpretation and suboptimal management.