Keloid as a Whole-Body Story: What a 2026 Review Suggests About Inflammation, Lifestyle, and the Limits of Local Treatment

Many people living with keloid quietly ask the same question: do the food I eat, the way I handle stress, and how much I move actually influence that stubborn scar? Do these variables push it to grow faster or make it more likely to come back after treatment? These questions feel natural because we sense that the body is not a pile of independent parts but an interconnected whole.

That intuition rhymes with older medical traditions. In the Ling Shu, volume five, in a passage on the origins of disease, the text states: "The beginning of the hundred diseases all arises from wind, cold, heat, the alternation of yin and yang, emotions, diet and dwelling, and great fright or sudden fear." In other words, the classical view already located the roots of illness in weather and environment, in emotional upheaval, in daily habits of eating and living, and in psychological shock, rather than treating disease as a purely local event.

A passage in volume six extends this idea through time, observing that spring generates, summer grows, autumn gathers, winter stores; this is the constant order of qi, and humans should align with it. It even divides a single day into four seasons: morning as spring, midday as summer, sunset as autumn, midnight as winter. Volume five also offers a compact rule: "The five phases have their order, the four seasons have their divisions; alignment brings order, opposition brings disorder."

It is important to be clear about what these passages are and are not. They are classical theoretical statements that frame how the body and disease relate to environment, emotion, and daily life. They cannot be directly equated with modern biomedical findings, and the article does not claim that modern research has proved the classical view. What the authors do is borrow the "from inside outward" perspective as a way to ask a new question in modern language: if a scar on the skin reflects the state of the whole body, should whole-body care also become part of treatment?

The article's core claims can be unpacked in eight layers. First, the therapeutic predicament is real: although tremendous progress has been made over the past decades in elucidating the mechanisms of keloid formation and developing therapeutic interventions, keloid remains challenging to cure and prone to recurrence. Second, the historical framing has limits: keloid has historically been regarded as a benign skin tumor, with mechanistic investigations and therapeutic efforts focused primarily on keloid tissue and cells themselves.

Third, Traditional Chinese Medicine offers a different lens: TCM posits that skin diseases manifest from internal bodily dysfunction or dysregulation. Fourth, the central proposal: inspired by the holistic principles of TCM, and together with the literature reports and clinical evidence of keloid constitution, a systemic condition characterized by an individual's predisposition to keloid formation, the authors propose that keloid is likely a pseudo-skin tumor profoundly influenced by its pathological microenvironment.

Fifth, inflammation is the key thread: the authors propose keloid as a persistent inflammation-driven proliferative skin disorder, and suggest that elimination of the inflammatory microenvironment may be essential for curing keloid and preventing relapse. Sixth, from this concept they developed a holistic therapeutic approach that combines systemic treatment targeting keloid constitution with local therapies, including surgery, chemo/radiotherapy, and compression therapy for the keloid lesion itself.

Seventh, the systemic component: it encompasses lifestyle and dietary modifications, stress management, physical exercise, as well as the oral administration of TCM herbal medicines and small chemical compounds to suppress systemic inflammatory and fibrotic status, thereby improving keloid constitution. Eighth, this article introduces this novel holistic approach along with supportive case studies.

A word on wording: the authors use careful language such as "propose," "likely," and "may be essential." That is because these are hypotheses and directions, not conclusions that have been validated by large-scale clinical trials.

The most interesting move in this paper is the way it connects two medical traditions that often seem far apart. Modern medicine tends to treat keloid as a local skin problem: cells proliferating too aggressively, scar tissue running out of control. Traditional Chinese Medicine tends to read the body as a whole, where the skin mirrors what is happening inside. The authors are not trying to prove which side is right; they are borrowing the holistic perspective as inspiration and re-describing keloid in modern language: it may not simply be a tumor of the skin, but the skin-level expression of a wider inflammatory and fibrotic tendency.

For an ordinary reader, the practical takeaway is that the body is a system. Diet, stress, sleep, and movement are variables associated with systemic inflammatory status, and this article folds them into a way of thinking about keloid care. That framing also resonates, across a long stretch of time, with the Ling Shu passage that locates the beginning of the hundred diseases in wind, cold, heat, emotions, diet and dwelling, and great fright or sudden fear. Both perspectives are saying, in their own languages, that one should not look only at the lesion, but at the soil that grows it.

It is equally important to stay clear-headed. The authors' holistic approach runs systemic care alongside local care, not in place of it. Surgery, chemo/radiotherapy, and compression therapy still occupy a place in their framework. In other words, the proposal is a "two-track" approach, not a claim that lifestyle can replace medical treatment.

When reading a perspective article like this, the most useful habit is to separate what is established from what is still being explored. The following boundaries are worth keeping in mind.

First, the difficulty of curing keloid and its tendency to recur is the status quo the authors acknowledge, while the claim that eliminating the inflammatory microenvironment will cure keloid and prevent relapse is their proposal, one that has not yet been validated by large-scale clinical trials. Second, the supportive case studies in the article can only show that this approach has been tried and appeared to help in some individuals; they do not prove that lifestyle changes alone cure keloid, and they should not be read as evidence of effectiveness.

Third, the oral TCM herbal medicines and small chemical compounds mentioned in the article are part of the research and treatment concept described by the authors, not prescriptions for readers. Any medication needs evaluation by a qualified clinician, and self-administration carries real risks. Fourth, "keloid constitution" in the TCM sense is a descriptive framework about predisposition; it should not be treated as equivalent to any biomedical diagnosis. Classical statements about disease arising from weather, emotion, diet, and dwelling are theoretical language, and the article does not claim that modern research has proved these classical claims.

Fifth, and easiest to misread: the article does not argue that diet and exercise can replace surgery or radiotherapy. In the authors' holistic approach, local treatment and systemic care run in parallel. For anyone dealing with keloid, the most reliable course is to discuss options with a dermatologist or relevant specialist, and to treat this article as a noteworthy new direction rather than a self-directed guide.

Keloid has long been described as a benign skin tumor, with most research and treatment focused on the scar tissue and the cells within it. Drawing on the classical view that skin conditions reflect internal bodily dysfunction, and combining this with reports in the literature and clinical observations of a so-called keloid constitution—a systemic tendency for certain individuals to form keloids—the authors propose that keloid may be better understood as a pseudo-skin tumor shaped by its pathological microenvironment. In their framing, keloid is described as a persistent, inflammation-driven, proliferative skin disorder, and reducing the inflammatory microenvironment is suggested as a potentially necessary step toward cure and relapse prevention.

The practical strategy that follows is deliberately two-pronged. Local therapies aimed at the lesion itself—surgery, chemo/radiotherapy, and compression therapy—remain part of the picture. Alongside them, the authors outline a systemic component that targets the underlying constitution: lifestyle and dietary modification, stress management, and physical exercise, together with oral traditional Chinese medicines and small chemical compounds intended to dampen systemic inflammation and fibrosis. Supportive case studies are included as illustrations of how this combined approach has been used in practice.

It is important to keep the limits of this proposal in view. The case studies are preliminary observations and do not demonstrate that lifestyle changes alone can cure keloid. The herbal medicines and compounds mentioned belong to the authors' investigational framework and are not presented here as reader prescriptions. The value of the article lies less in offering a finished answer and more in reframing keloid care as an integrated practice, in which local treatment and whole-body support work in parallel rather than as substitutes for one another.