Keloids
Keloids and hypertrophic scars can be extremely distressing for those who suffer with them. They are often extremely difficult to treat and can be the source of embarrassment especially if they are in easily visible areas. At Rejuvence we do not claim to have a magic cure for keloids and hypertrophic scars but we do offer a range of treatments that can help.
What are keloids?
Keloids or keloid scars develop as a result of an overgrowth of collagen over cuts or wounds or following procedures such as ear piercings or tattoos. They can also occur after treatments such as aggressive lasers or deep chemical peels. Keloids are defined as raised scars that extend beyond the borders of the original cut or wound. They can grow to significant size and can often also be associated with itching and peeling.
Where do keloids normally occur?
Keloids normally occur over the upper chest, breast bone, shoulders and upper arms, ears, scalp, back and lower legs. They are particularly common after cuts and wounds to the shoulders and back as well as after ear piercings. As mentioned earlier they can also occur after certain cosmetic procedures in susceptible ethnic groups, especially those with darker skin types.
Who are most likely to develop keloids?
Keloids are not particularly common but certain ethnic groups can be quite prone to them. Specifically Afro-Carribeans, Asians (from the Indian Subcontinent) as well as certain Mediterranean groups can develop keloids. They are not contagious but can run in families.
Can keloid scars be treated?
Keloids are extremely difficult to treat. Hence prevention is the best approach. For those individuals who are likely to be prone to keloids it is best to avoid specific types of cosmetic treatments and procedures except if absolutely necessary. These individuals should also be extremely careful when it comes to getting their ears pierced or having tattoos done. They should especially avoid keloid prone areas such as the chest, back, shoulders and upper arms.
©Individual results may vary.
What can we do at Rejuvence Clinic?
At Rejuvence we have experience in treating clients who suffer with troublesome keloids. We are able to provide a course of steroid injections into the scars themselves and often follow up in between treatment sessions with topical steroid creams. We are also able to carry out excision of the keloids and will recommend a combination of steroid injections afterwards along side compression bandaging (depending upon where the keloids are) and silicone gel and strips. We have had some excellent results but always advise our clients that there is a high risk of recurrence. We understand the distressing nature of keloids and how they can severely affect one’s self esteem and confidence. Book a consultation to find out more.
Unfortunately there is no cure for keloids and all treatments are limited in their success with a risk of recurrence. Typical treatments include intralesional injection of medication including steroids, muscle relaxing toxin and chemotherapy agents into the keloid scars, topical steroid creams and dressings, compression garments, silicone gel sheets, cryotherapy, cutting out of keloid scars and radiotherapy.
Injection of steroids into keloid scars, also known as intralesional steroid injections, has been shown to produce positive results and is considered to be first line treatment.
After a series of repeated treatments over the course of a few months, steroids can help to shrink keloid scars. Steroids can also help with other symptoms associated with steroids including itching and pain.
Side effects associated with steroid treatment include lightening of the skin over the keloid (also known as hypopigmentation) and thinning of the skin. Hypopigmentation is normally temporary and can be reversed with application of a specific ointment. The steroid injections themselves can be quite sore. It is often necessary to add in some local anaesthetic with the steroids and use topical anaesthetic creams prior to treatment. Supplemental steroid creams can be applied in between steroid injections to help keep it at bay.
Recent research has shown that the best results for keloid and hypertrophic scars are achieved through a combination of treatments as opposed to relying on a single treatment. Recent published research has shown that intralesional scar injections with muscle relaxing toxins (the same medication used in wrinkle relaxing injections for the face) and certain specific chemotherapy agents can be combined with other treatment options to improve the results of keloid scar treatment. At Rejuvence we especially use muscle relaxing toxin injections prior to and after surgical excisions of certain types of keloid scars. We have found that this can significantly reduce any rates of recurrence and we especially use this for the treatment of keloids on the scalp and back of the head and neck. -Acne Keloidalis Nuchae.
Often, many patients would prefer for their keloid scars to be completely removed through excision (cutting out). This can be performed depending on where the keloids are and is normally carried out under local anaesthetic. However, it is very important to bear in mind that there can be a high rate of recurrence and sometimes the keloids can come back more aggressively. Once excised, immediate repeated treatments with steroid injections can help to reduce the risk of recurrence and some large specialist units advocate using radiotherapy in the postoperative period to further reduce the risk of keloids coming back.
Surgery for keloids specifically on the ear, in combination with steroid injections and the regular use of a compression earring can help reduce the recurrence rate significantly. At Rejuvence we have managed to achieve excellent results with low rates of recurrence through this approach.
Cryotherapy for the removal of keloid scars is a well established treatment option. Cryotherapy can be intralesional and surface cryo. Intralesional cryotherapy involves freezing the keloid from the inside by injecting a probe into the keloid and treating it with liquid nitrogen. This results in the scar shrinking. Surface cryotherapy consists of freezing the keloid on it’s surface. Studies have shown, however, that final outcomes with traditional excision and steroid therapy are still better than cryotherapy. At Rejuvence Clinic we recommend excision over cryotherapy. However, there are instances where cryotherapy is more appropriate. At Rejuvence we have the experience to judge which techniques are likely to give the best results.
Compression garments are often useful alongside silicone gel sheets but more so as a preventative measure rather than a sole treatment for established keloid scars. They are often used after the keloids have been surgically removed in an attempt to prevent them from coming back. Sustained physical pressure over the scar helps to prevent the build up of collagen above the scar and hence reduces the risk of a keloid reforming. At Rejuvence Clinic we recommend using compression garments where possible to prevent recurrence of the keloid. We can provide compression garments at an additional cost.
Silicone gel is often recommended for use after any surgical procedure to improve the appearance of scars. Regular massage of scars, once they have completely healed, helps to organise the skin cells and keep them flat and in line. Silicone gel sheets are also extremely helpful for the improvement of the appearance of scars. We always recommend using silicone gel and silicone strips after keloid surgery.
Can Laser help improve hypertrophic and keloid scars?
Laser treatment in the form of Nd:YAG 1064nm wavelength laser has been found to be very effective in the treatment of hypertrophic and keloid scars especially in Skin Types I-IV. Nd:YAG laser targets the superficial blood vessels in scars that are quite red and of a contrasting colour and can help to reduce this. They also result in the transfer of heat to the deep dermis (deep layer of the skin) and breakdown of the scar followed by new and more organised collagen regrowth improving hypertrophic and keloid scars. Nd:YAG laser in combination with intralesional steroid treatment has been shown to demonstrate excellent cosmetic improvement in the appearance of keloids. At Rejuvence we combine laser with other treatments to give excellent results. For further information on laser treatment options for hypertrophic and keloid scars at Rejuvence click here.
