Scar and Keloid Reduction
Keloids are firm, almost woody often bright pink or red scars, sometimes shiny and looking brown in colour – especially in darker skintypes. They are differentiated from normal hypertrophic scars by the fact that keloids spread beyond the area of the wound, where as hypertrophic scars do not.
- Keloids were documented in ancient Egypt by 1700B.C, also by the Indians and Chinese.
- Keloids can be large enough to restrict movements near joints and show through clothing.
- We have seen keloids the size of a mans fist after a simple injection or blood test.
Why and How do we get Keloid?
Keloids are thankfully relatively uncommon and generally form within a scar. Collagen overgrows somewhat out of control producing a lump much bigger than the wound itself. They are NOT cancerous. Although keloids usually occur at the site of an injury, they can also arise without any injury or from just a needle prick in susceptible individuals. (this is why individuals likely to keloid often have their TB jab on the leg instead of the arm.
They can occur at the site of an ear piercing and even a pimple or a scratch especially repeated scratching, even in those not prone to them. (However tempting don’t pick those scabs).
Keloids affect both sexes equally, with a much higher frequency in those with darker skin types. Those of African or Jamaican origin are at highest risk of keloid.
Where do we get Keloid Scars?
Keloids can develop anywhere!
However there are high risk zones especially over the breast bone, back and shoulders as well as the ear lobes in people having piercing when adult.
Children under 11 are much less likely to develop keloid.
Black skinned individuals are at much higher risk and commonly present with a condition known as pseudofolliculitis barbae with brownish keloid scarring as an additional complication, especially when they keep shaving and irritating their shaving bumps often caused by curly ingrowing hair. This can be very disfiguring for women who can be forced to shave on a daily basis.
Our hair removal treatment is very helpful in dealing with this issue before too much damage is done. See link our link to hair removal.
Treatments for Keloids
With Keloid, prevention is definitely better than cure.
These are the most common therapy in the UK for most keloids. Slow difficult progress with up to 50% recurrence over 5 years. As keloids are so firm in texture it is difficult to inject them.
Fortunately as they are so firm, absorption is poor and not much steroid gets in to the systemic circulation.
Why Dont You Cut Them Out Doctor!
By Scalpel: reported 50-100% recurrence this falls considerably in those treated with steroids or radiotherapy as well as excision.
However, steroid injections in to a wound are not a popular treatment and radiotherapy leaves a small risk of skin cancer in a lesion that is benign albeit disfiguring.
By Radiosurgery: Anecdotally appears to give better results than a knife but it is extremely dependent on the skill of the operator (as is mole removal). They do still recur, especially at high risk sites in high risk patients.
Remove by Laser: best to avoid this completely. We have see many disasters with a much bigger keloid at the end.
This is an exciting area in treatment of keloids and may be of help to those with the most disfiguring lesions on prominent sites that are difficult to remove in any other way.
We believe that this will be the keloid therapy of the future.
See Recell cell therapy
Silicone gel sheeting
Nobody knows how this works. Does seem to have an effect, we have seen marginal change and reduction of symptoms such as pain and itching. There is considerable disagreement in dermatological circles as to their usefullness.
Don’t do it! Rarely successful on it’s own and adds ulceration, a lot of pain and a big white mark at the treatment site to your woes.
Very successful 70-90% reduction but risks of skin cancer /problems later in life as a consequence make this a therapy of last resort at present (see above).
May help if injected on to wounds at time of surgery, evidence is limited.
Mostly a waste of time on their own. There is work underway with newer fractional CO2 lasers – watch this space. Some colour lasers, such as the KTP laser and/or pulse dye lasers can be helpful in softening up keloids so that they can be injected more easily with steroids.