When should I consider referring a patient with keloid scars to a specialist for further management?

Consider referring a patient with keloid scars to a specialist when:

• There is diagnostic uncertainty about the nature of the scar, especially if it is atypical or difficult to distinguish from other types of scars or skin lesions.
• The keloid scar is causing significant symptoms such as pain, pruritus, or functional impairment that are not controlled by primary care management.
• The scar is extensive, rapidly growing, or recurrent despite initial treatment attempts in primary care.
• The patient experiences significant psychological distress or social impact related to the appearance or symptoms of the keloid scar.
• Specialist interventions are being considered, such as intralesional corticosteroid injections, laser therapy, surgical excision, or other advanced treatments that require specialist expertise.

Keloid scars are a type of problematic scar characterized by excessive collagen deposition beyond the original wound boundaries, often leading to raised, firm, and sometimes symptomatic lesions. Management in primary care is limited, and referral to dermatology or plastic surgery specialists is appropriate when conservative measures fail or when advanced therapies are indicated (Pym, 2006). Early specialist involvement can help optimize treatment outcomes and reduce the risk of recurrence or complications.