Keloids are an abnormal form of wound healing characterized by an overgrowth of scar tissue that extends beyond the original injury site. This excessive tissue is a benign fibroproliferative tumor, fueled by the persistent, dysregulated production and accumulation of collagen in the dermis. Keloids rarely regress spontaneously and have a high propensity for recurrence, meaning instantaneous removal is not medically possible. However, clinical interventions can achieve rapid reduction in size and symptoms, setting the stage for long-term management.
Clinical Methods for Rapid Reduction
The fastest way to achieve a noticeable reduction in keloid size and symptoms is through in-office procedures that directly target the overactive scar tissue. Intralesional corticosteroid injections, primarily using Triamcinolone Acetonide, are often the first-line treatment for size reduction. This compound suppresses inflammation, reduces oxygen and nutrient delivery to the wound, and inhibits the fibroblasts responsible for excessive collagen synthesis. Injections are administered directly into the keloid tissue every four to six weeks, continuing for up to six months. This approach often leads to significant flattening and softening within the first few sessions. Dermatologists may combine the corticosteroid with agents like 5-Fluorouracil (5-FU), an anti-tumor agent that further limits cell proliferation.
Cryotherapy is another method, involving freezing the keloid from the inside out using liquid nitrogen. This procedure damages the cells and blood supply within the scar, causing it to flatten and shrink. Cryotherapy is frequently combined with corticosteroid injections to enhance effectiveness and reduce the risk of tissue atrophy.
Surgical Excision and Advanced Therapies
For larger or more established keloids, physical removal through surgical excision may be necessary to achieve the desired cosmetic outcome. Surgery alone carries a significant risk of recurrence, with rates between 50% and 80%, because the incision creates a new wound that can trigger an even larger keloid. Therefore, surgical removal is almost always paired immediately with an adjunct therapy to prevent regrowth.
The most effective adjunct therapy is Superficial Radiation Therapy (SRT), a low-dose treatment applied directly to the wound site. SRT targets and suppresses the fibroblasts that rapidly divide and produce collagen post-operatively. This treatment is time-sensitive and must begin within 24 to 48 hours of the surgical excision to interrupt the abnormal healing cascade.
Combining surgery with SRT significantly lowers the recurrence rate, often down to 10 to 20% or less. The radiation is delivered over a few short sessions, typically one to three days, and is precisely calibrated to penetrate only a few millimeters beneath the skin, minimizing damage to deeper tissues. Alternative adjunct therapies include immediate and repeated intralesional injections of corticosteroids or other anti-proliferative agents into the wound edges.
Essential Post-Treatment Care to Prevent Regrowth
Following either a clinical reduction procedure or surgical removal, the long-term success of keloid treatment depends heavily on consistent post-treatment care aimed at preventing recurrence. The two primary strategies involve pressure and silicone therapy.
Pressure therapy utilizes custom-fitted compression garments or pressure earrings, particularly for earlobe keloids, to apply continuous pressure to the treated area. The pressure, ideally maintained at 24 to 30 millimeters of mercury for 12 to 24 hours daily, works by decreasing blood flow to the area and promoting the reorganization of collagen fibers. Patients must commit to wearing these devices for a minimum of six to twelve months to achieve sustained flattening and softening of the scar.
Silicone therapy, in the form of adhesive sheets or topical gels, is also a foundational component of post-treatment care. The silicone creates an occlusive barrier over the treated skin, which helps to hydrate the scar tissue by reducing trans-epidermal water loss. This moist environment regulates fibroblast activity and reduces collagen production. For maximum benefit, silicone products should be worn against the skin for at least twelve hours per day for several months, often in conjunction with pressure garments.