Millions of people have pierced ears with no more unsightly results than an unfortunate taste in earrings. In some cases, however, the healing process runs amok and results in a misshapen scar called a keloid. While there's no guaranteed way to remove the scar, a new technique developed by R. James Koch, MD, may help eliminate the unattractive tissue.

Keloids result when overzealous skin cells lay down disorganized bundles of a protein called collagen as they heal. Although they are relatively rare, these unusual scars occur in up to 15 percent of dark-skinned people between the ages of 2 and 40. Some parts of the body are more prone to keloids than others.

"Everybody who gets cut on the shoulder will develop a bad scar," said Koch, assistant professor of surgery at the medical school. "Skin cells are different there," he said, adding that the outer reaches of the face — such as the ears — are also more keloid-prone, as is the chest.

Because keloids are the result of healing itself, surgeons are often wary of removing them for fear of sparking another round of growth. "Each treatment may get rid of the keloid or upset it and make it grow back larger," Koch noted.

Despite these odds, people with particularly large or visible keloids accept the risk in their eagerness to eliminate their unsightly blemish. In these cases, Koch said that lasers are an accepted treatment. "It's just a matter of whether they truly make a difference," he said.

Koch tested a combined carbon dioxide and erbium laser used to treat keloids. The results, published in the December issue of Archives of Facial Plastic Surgery, indicated that the laser induced an identity switch in keloid-producing cells grown in the laboratory. Those cells began producing growth factors that slow the rate at which they lay down collagen, similar to normal cells, rather than producing the type of growth factors seen in keloid-forming cells.

Koch expects that by using this laser to remove keloids, the region will heal with less-abundant scar tissue.

Koch's job doesn't end with keloids, however. "What I learn from keloids I can apply to other injuries and to wound healing," he said.

He hopes to develop techniques to switch cells into different healing modes. As an example, he said that in diabetic people with sores on their legs, the ability to switch a slow-healing cell into one that heals quickly would be worth any scar that results.