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What are Keloid scars?

A keloid is a type of scar that appears swollen and elevated. It may appear as skin coloured, yellow,  red or dark and is generally identified as; smooth and shiny, generally little to no hair on the area, dark shaded before becoming light brown and rough or rubbery.

A keloid scar occurs secondary to a defective wound that heals larger than the original wound. It can grow and change in texture, making it more noticeable, and, in some cases, be a case for aesthetic treatment. The keloid itself can affect the scar tissue but also grow beyond the boundaries of the initial injury.

The primary cause of a keloid scar developing is due to the healing process triggering an over development of collagen and fibrous connective tissue (fibroblasts). Keloids are often classified as benign tumours, and some keloid scars may also cause itching, hypersensitivity, itching, or general discomfort.

Those with the highest risk of developing keloid scars include those with wounds under tension, darker skin, aging skin, and whether you have a past history of keloid scarring.

How are Keloids diagnosed?

A specialist doctor or dermatologist can usually visually diagnose a keloid due to its distinct appearance. If in the case a keloid requires further investigation, a doctor may perform a skin biopsy. This involves making an incision in the tissue and removing a part of the keloid so that it can be studied under a microscope.

What treatments are available for Keloid scars?

Possible types of keloid treatments include the following:

  • Steroid (triamcinolone) or corticosteroid injections into a keloid may effectively flatten the smaller ones in their early stages.
  • Applying steroid-impregnated tape for 12 to 24 hours a day may help to flatten keloids.
  • Putting a silicone sheet over them at night for several months helps some keloids to flatten. Silicone in gel form is also available.
  • Laser treatment makes keloids less red but does not make them smaller.
  • Cryotherapy: Involves freezing the scar and is usually more suited to keloids of recent onset, particularly smaller lesions. Duration and thickness of the keloid are the most important factors when considering suitability for cryotherapy treatment​
  • Pressure treatment: After keloid surgery, maintaining pressure on the area can help keep a keloid from reoccurring as it reduces blood flow.

How does keloid surgery work?

Much like most scar revision surgeries, doctors aim to use surgical procedures to help the scar blend in with the surrounding skin. Minimising the appearance of scars by repositioning, reducing the size of the scar, or smoothing the contours of the skin are just some of the ways that the surgery works – and the same techniques can be applied to keloid surgery.

At the primary stages of keloid surgery, a doctor will first analyse the extensity of the keloid scarring. If the keloid far exceeds the margin of the original wound, reconstructing the skin tissue in the surrounding areas and restoration of the underlying structure would be required. Keloid surgery involves surgically cutting out the keloid, and although typically seen as a permanent solution, the rate of the keloid returning after surgery is high.

To reduce the likelihood of another keloid forming – after the first keloid surgery – additional keloid treatment may be recommended as a follow-up. This can include cryotherapy, radiation treatment or pressure treatments – depending on the body area the surgery was conducted on.

Prior discussion with your doctor, to understand the treatment process will help you decide if keloid surgery and any follow-up treatments are the best courses of action.

What to expect after keloid surgery?

Our qualified doctors will place a bandage that has been sterilised over the wound after surgery. They may prescribe pain relief medication if the surgery is extensive to help you heal comfortably. Six to eight days post-surgery, the doctor will schedule a follow-up appointment to assess recovery, healing progress and remove stitches if necessary.

The skin heals over the next six to eight weeks, and the new, smaller scar begins flattening and fading to match the surrounding skin. Total recovery will take up to a year. During this time, doctors schedule further follow-up appointments as necessary to monitor how the scar heals.

As mentioned before, doctors may administer a corticosteroid injection if a hypertrophic scar or keloid appears to be forming after surgery, if necessary. If you have a history of developing keloids, surgeons may plan several appointments during the months following the surgery to inject corticosteroids into the scar tissue in an attempt to prevent a recurrence.

Alternatively, doctors or dermatologists may recommend postoperative radiotherapy treatment to prevent another keloid from forming. For best results, this therapy is typically performed within 24 to 48 hours of surgery.

How does intralesional steroid injection for Keloids work?

The procedure of this treatment involves injecting intralesional steroid solution into the abnormal skin and aims to improve the appearance of the keloid scar as well as relieving symptoms such as itching or pain.

We perform intralesional injection of a steroid in the procedure room at Clinica London. No special preparation is required, and a local anaesthetic is not needed. Depending on the size of the area to be treated, you may need several injections. This type of treatment can work alongside laser treatment for keloids.

There are some side effects to intralesional steroid injection this type of therapy, which we discuss before the treatment.

What is cryotherapy for keloids?

Dermatologists have found that patients who have three or more cryotherapy treatments tend to get the best results.

This treatment freezes the keloid from inside out while the skin under the keloid is being preserved. It is used to reduce a keloid’s size and level of hardness, and this treatment works best on smaller keloids.

Cryotherapy treatments before (or after) receiving corticosteroid injections is recommended to reduce a keloid’s size further, as it may make the injections more efficient. Three or more rounds of cryotherapy treatment sessions appear to get the best results on patients.

What is the best treatment for my keloid?

There are different keloid treatment’s, which range from aesthetic requirements to addressing the physical symptoms. On occasions, treatments can get rid of the keloid or reduce the size. However, even after successful treatment, some keloids return. Following the doctor’s instructions will allow you the get the best results from the treatment and reduce the likelihood of a keloid returning.

Consult your doctor on which treatment options are available and suitable to you. Depending on the size of the keloid a more non-invasive treatment will suffice, but in more complex cases a course of treatments may be advised. Discussing your options with a qualified doctor will help determine whether a one-off treatment or combination treatment is required.

If you are considering Keloid Scar treatment you can see our prices for treatment and consultation.

Read more about Keloid Scars condition.

Dr Jennifer Crawley

Consultant Dermatologist
Children & Adults

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Dr Angela Tewari

Consultant Dermatologist
Children & Adults

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