A keloid is a raised scar that grows beyond the original boundaries of the wound that caused it. These scars can develop after a skin injury, such as a cut, burn, acne, surgery, or a piercing. Unlike other raised scars that fade, keloids do not regress and often continue to grow slowly.
People seek keloid treatment for various reasons, including cosmetic concerns, discomfort, itching, and pain. In some cases, if a keloid forms near a joint, it can restrict movement. Treating keloids is complex and requires a personalized approach due to their tendency to recur.
Understanding Surgical Excision
Surgical excision is a common method for removing keloids, involving the complete cutting out of the visible scar tissue. The goal is to remove the bulk of the keloid, aiming for a smooth, flat surface. During surgery, the keloid is incised and removed, and the skin is then closed using careful suturing techniques. This process is usually performed under local anesthesia, ensuring the patient’s comfort.
Unlike tumor removal, where clear margins of healthy tissue are taken, keloid excision involves removing the entire visible lesion without wide margins. Attempting to remove surrounding healthy tissue can stimulate further keloid growth. While the aim is complete removal, surgical excision alone carries a high risk of recurrence, sometimes between 45% and 100%. Therefore, surgery is often combined with other treatments to improve outcomes.
Exploring Non-Surgical and Combination Therapies
Non-surgical treatments play a significant role in managing keloids, by reducing their size, preventing growth, or complementing surgical removal. Corticosteroid injections, often using triamcinolone acetonide, are a common first-line treatment. These injections suppress inflammation, reduce collagen synthesis, and inhibit fibroblast activity within the scar, leading to flattening and softening. Injections are given directly into the keloid, often monthly for several months.
Cryotherapy involves freezing the keloid tissue to destroy cells responsible for scar formation. This method can reduce keloid volume and is particularly effective for smaller keloids. Laser therapy, such as pulsed-dye laser, can help flatten keloids, ease itching, and improve their color by targeting blood vessels and promoting collagen remodeling. Multiple sessions are usually required.
Silicone gel sheets and dressings are another non-invasive option, creating a hydrated environment over the scar and applying gentle pressure. This helps regulate collagen production, leading to a flatter, softer, and less noticeable scar. Pressure therapy, using compression garments or devices, applies continuous pressure to the keloid, which can reduce its size and prevent excessive collagen. These non-surgical methods are frequently used in combination with surgery, such as corticosteroid injections or silicone sheets applied after excision, to reduce recurrence and enhance treatment effectiveness.
Key Factors Guiding Treatment Decisions
The decision of how much keloid to remove and which treatment approach to use is highly individualized. The keloid’s size and location are important considerations; for instance, small keloids might respond well to injections or cryotherapy alone, while larger or more extensive keloids often require surgical excision. Keloids on areas like the earlobes, chest, or shoulders are more common and may have different treatment considerations due to tension or cosmetic prominence.
A patient’s age, medical history, and previous keloid treatments are also important factors. A history of keloids or a tendency to form them can influence the aggressiveness of the treatment plan. The patient’s cosmetic goals and expectations are paramount, guiding the choice between methods that primarily reduce size versus those aiming for near-complete removal and aesthetic improvement.
The risk of recurrence is a significant concern for keloids, influencing the decision to combine treatments. Some individuals are more prone to keloid formation, and this predisposition affects the long-term management strategy. A dermatologist or surgeon carefully evaluates these factors to determine the most appropriate and effective approach, tailored to the specific keloid and patient.
Preventing Recurrence After Treatment
The amount of keloid removed is only one part of successful keloid management; preventing recurrence is equally important due to the high likelihood of regrowth. Post-treatment care is crucial to stop the keloid from returning, often larger than before. A common strategy is the immediate injection of corticosteroids into the treated area after surgical excision. These injections help suppress inflammation and collagen production, reducing the chance of regrowth.
Radiation therapy is another important post-operative measure, particularly for high-risk keloids or those that have recurred. Administered shortly after surgical removal, often within the same day, low-dose radiation helps inhibit fibroblast proliferation and collagen production, significantly lowering recurrence rates. Studies show that radiation therapy after excision can reduce recurrence rates to around 20%.
Pressure garments and continued silicone therapy are widely used after treatment. Pressure garments apply consistent pressure to the healing site, helping to flatten the scar and prevent excessive tissue. Silicone gel sheets or topical silicone products, applied for several months, keep the scar hydrated and regulate collagen, contributing to a smoother scar and reduced recurrence risk. Patient adherence to these follow-up treatments is essential for long-term success in preventing keloid regrowth.