**Core Concept**
Keloids are a type of raised, thickened scar tissue that forms after skin injury, characterized by an excessive deposition of collagen and other matrix proteins. This process is mediated by an abnormal wound healing response, involving the activation of fibroblasts and the release of various growth factors.

**Why the Correct Answer is Right**
The correct answer is related to the pathophysiology of keloid formation. Keloids are known to be associated with an increased expression of transforming growth factor-beta (TGF-β), which stimulates the proliferation and differentiation of fibroblasts, leading to the excessive deposition of collagen. This process is also influenced by the release of other growth factors, such as platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF). The resulting keloid scar tissue is composed of a dense, irregular arrangement of collagen fibers, which gives it a characteristic raised and thickened appearance.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not accurately describe the pathophysiology of keloid formation. While inflammation is a component of wound healing, it is not the primary mechanism underlying keloid development.
**Option B:** This option is incorrect because it is not specific to keloids. Hypertrophic scars, like keloids, are also characterized by an abnormal wound healing response, but they do not exhibit the same degree of excessive collagen deposition.
**Option C:** This option is incorrect because it is not directly related to the pathophysiology of keloid formation. While keloids can be itchy or tender, these symptoms are not the primary characteristics of the condition.

**Clinical Pearl / High-Yield Fact**
Keloids are more common in individuals with darker skin types, and they tend to occur in areas with high tension, such as the chest, back, and earlobes. This is due to the increased expression of TGF-β and other growth factors in these areas, which stimulates the abnormal wound healing response.

**Correct Answer:** D