Keloid Scars; At A glance
- Best Results2-8 sessions
- Treatment Recovery0 days
- Procedure Time5 minutes
- Skin SpecialistDavin Lim, Dermatologist
- Duration of ResultsLong term
- AnaestheticNumbing + local blocks
- Back to WorkImmediately
Keloid scars are commonly found on the chest, shoulders, back & jawline. Fortunately, the majority of scars can be treated with simple injections & lasers. Keloids are more common in younger adults. Prevention is the key to long term management.
FactsFacts on Keloid Scars
- Keloid & hypertrophic scars are due to excessive collagen formation
- Keloids are more common in ethnic skin types, including Asians & Africans
- The most common secondary cause is acne & surgery
- Keloids can occur after piercings or trauma
- Keloids are often itchy, occasionally they may be painful
- Non-surgical options include silicone gel, lasers, anti-inflammatory injections, freezing, surgery & radiotherapy
- The majority of cases respond to simple injections, spaced 6 to 10 weeks apart
- Typically a series of 2 to 10 injections are required
What is a keloid scar?
Scars can be raised (hypertrophic or keloid scars), or they can be depressed (atrophic scars). Keloid scars extend beyond the margin of the injury, whilst hypertrophic scars are within the scar itself. Keloids can be itchy, painful or asymptomatic.
The most common locations for keloid scars are the chest, shoulders, back, ear, jawline & areas of surgical scars.
Why do keloids people get keloids?
Keloids & hypertrophic scars are common in young people. They are due to excessive collagen production, resulting in a raised scar. Keloids by definition extend beyond the boundary of the scar. Trauma (such as ear piercings) can predispose patients to keloid scars. Other risk factors for keloids include –
- Gender. Females are more likely to get keloid scars.
- Ethnicity, more commonly seen in Asian and darker skin types.
- Age. Collagen production is accelerated in younger people compared to older patients
- Inflammation & location; pressure areas such as the shoulders, back & chest areas are more prone to scarring, including areas prone to acne
- Thermal injury such as burns can elicit an exaggerated healing response.
- Surgical wounds including excision of moles & C-sections
What can you do before seeing a dermatologist?
The most important aspect of management is to prevent other keloids from forming. This means if you have active acne, control it. Discuss with your GP methods to do this.
You can try silicone dressings such as Stratagel or another silicone gel; ask your pharmacist as to what they stock.
What treatments are there for keloid scars?
Keloids scars can respond to lasers & injections. It is advisable to trial a series of these treatments before more radical procedures including surgery & radiotherapy. Treatment options include-
- Steroid injections. These are usually repeated at 6-8 weekly intervals.
- 5FU or chemotherapy injections. Repeated 6-8 weeks apart.
- Cryogen or cryoprobe, often in conjunction with steroid injections.
- Botox; this has been reported in the literature (low success rate).
- Silicone gel or sheeting, good as a prevention (Stratamark)
- CO2 fractional laser; in combination with anti-inflammatory steroids
- Microneedling with steroid drip
- Vascular laser +/- anti-inflammatory injections
- Radiotherapy (fractionated, 4-10 sessions)
- Verapamil or Bleomycin injections
The ideal treatment will depend on the location of the scar, the size, your age & your past treatment (failures). In the majority of cases, steroid injections are the first step.
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How many treatments will I require?
2 to 10, depending on the extent of keloid scarring. Most patients undergo treatments spaced every 6 to 10 weeks. For larger lesions, it can take up to 18 months (& beyond) to flatten these lesions.
In some cases, I employ vascular lasers or fractional CO2 lasers, alternating with steroid injections.
Are creams effective in the treatment of scars?
Creams & gel can be effective in the management of small & early scars. Your GP can prescribe a steroid ointment such as Diprosone, use 7 nights on, with a one-week break. Continue for at least 3-4 cycles.
Silicone gel can help some cases of early keloids. A good brand is Stratagel. Silicone sheets are also excellent. Pressure tape can be used to reduce the chances of keloids after surgery.
Do keloid scars go away on their own?
Spontaneous resolution is rare. Some keloids grow slowly, whilst others have rapid growth. If you have one keloid, chances are you will get more. Early intervention is the key to management.
How do you flatten a keloid naturally?
The best natural method (that may work with very early & small keloids), is pressure. This can be achieved with tape, or for areas such as the ears a pressure earring. In the majority of cases, pressure alone will not treat larger more established scars, however pressure after a procedure gives a higher percentage of success.
Will I develop other keloid scars?
If you are prone to keloids or hypertrophic scarring, you are prone to develop more scars. This is especially true for surgical scars. Notify your doctor prior to any procedure. For women who are planning to have a c-section, plan ahead! Namely, have a treatment plan PRIOR to surgery. It is much easier to prevent or treat early scarring. Pressure tape, combined with silicone gel & vascular lasers can reduce the chances of scarring.
If you have a mole that requires a biopsy, inform your surgeon that you are prone to keloids as they can reduce the risks of unwanted scarring. Another option is to have this mole checked for a second option by a medical dermatologist. This may save an excision in the first place.
When is surgery indicated for the treatment of keloids?
Surgery alone creates a new wound that will likely develop a keloid, further extending the lesion. When treated with surgery alone, keloids usually come back, hence the use of radiotherapy postoperatively.
In the majority of cases we will get a preoperative radiotherapy consult prior to any surgery. Radiotherapy is performed immediately after surgical intervention. This procedure is performed by a radiation oncologist specialist. Most patients require multiple treatment of radiotherapy over weeks (3 to 20 sessions over 2 to 6 weeks).
How do you prevent keloids?
As soon as the wound heals, begin using silicone sheets or gel. Applying silicone sheets or gel can help prevent keloids from forming and reduce the size of existing scars. You can buy these products without a prescription. Early use of anti-inflammatory creams can help.
If you are prone to acne, you must effectively control all inflammation in order to reduce keloid scars. Early management of the smallest scar can reduce the chances of keloids.
There are many surgical techniques that can reduce the chances of scar formation. These include orientation of the scar, correct length to width ratio, low tension closure, eversion of edges, low reactivity sutures, timely suture removal, & proper postoperative care. Your dermatologist or plastic surgeon will know these basic techniques.
Keloid Scars Treatment
Davin’s take on keloid scars
This phenomenon is super common, especially in ethnic patients. The typical profile is as follows- young patients, darker skin types, female, sites include chest, back, shoulder, jawline & ears. Early lumps can be prevented with simple silicone gel, taping & pulsed anti-inflammatory ointments.
When patients see me, my usual treatment is with intralesional corticosteroids injections. This may be effective for small to medium keloids. I also use 5FU injections as well as vascular & CO2 fractional laser resurfacing for larger lesions.
In severe/recurrent cases postoperative fractionated radiotherapy can be useful, usually after surgical excision. If you have ear keloids my usual treatment is excision followed by 4 to 6 months of pressure earrings. If you are prone to have exaggerated scarring elsewhere. Notify your doctor (or tattoo artist) prior to any procedure.
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