Keloids are a distinctive type of raised scar that can develop following various forms of skin injury. Unlike typical scars that fade over time, keloids often extend beyond the original wound boundaries and can become quite prominent.
What Keloids Are
Keloids are a distinct form of scar tissue that develops following skin injury. They extend beyond the original wound site, appearing as firm, rubbery, or shiny raised lesions. These growths can vary in color from pink to red or even darker than the surrounding skin and may cause itching or pain. They can form after various types of skin trauma, including surgical incisions, burns, acne, piercings, or even minor scratches.
The formation of keloids involves an overproduction of collagen, a protein crucial for wound healing, by cells called fibroblasts. Individuals with a genetic predisposition, particularly those with darker skin tones, have a higher likelihood of developing keloids. It is important to distinguish keloids from hypertrophic scars; while both are raised, hypertrophic scars remain confined to the original injury area and may naturally diminish over time, whereas keloids actively spread beyond these borders and typically do not regress.
Non-Surgical Treatment Options
Non-surgical approaches manage keloids by aiming to flatten them and reduce symptoms. Intralesional corticosteroid injections are a common first-line treatment. These injections work by reducing inflammation, diminishing collagen synthesis, and inhibiting enzymes that prevent collagen breakdown within the keloid. Injections are usually administered every three to six weeks for several months, with results becoming noticeable over a series of sessions rather than immediately.
Cryotherapy involves freezing the keloid tissue using liquid nitrogen, which destroys cells and reduces blood supply to the scar. This method can be effective in flattening smaller keloids, often requiring multiple short sessions. Potential side effects include temporary pain, blistering, or changes in skin pigmentation, particularly in individuals with darker skin tones.
Silicone sheets and gels are popular topical treatments that create an occlusive barrier over the keloid, hydrating the tissue and modulating collagen production. Consistent use, often for several months, is necessary for noticeable softening and flattening of the scar. Pressure therapy, which involves applying continuous pressure to the keloid with specialized garments or devices, is particularly effective for earlobe keloids and large scars. This sustained pressure helps to reduce blood flow and inhibit excessive collagen formation, requiring diligent adherence for many months to achieve results.
Surgical and Advanced Interventions
Surgical excision provides a direct method for removing keloid tissue. However, simply cutting out a keloid carries a high risk of recurrence, as the underlying biological factors that caused the initial excessive scarring can lead to an even larger keloid forming at the surgical site. For this reason, surgical removal is almost always combined with other therapies to minimize recurrence.
Laser therapy can improve keloid appearance. Pulsed dye lasers target blood vessels within the keloid, reducing redness and flattening the scar, while CO2 lasers can be used to ablate or vaporize keloid tissue. Laser treatments often require multiple sessions and are frequently used in conjunction with other modalities, such as corticosteroid injections, to enhance outcomes.
Radiation therapy is a powerful adjunctive treatment typically administered after surgical excision to prevent keloid regrowth. It works by inhibiting fibroblast activity and collagen production in the healing wound. Radiation is usually given in a series of low doses shortly after surgery, significantly reducing recurrence rates. Other advanced treatments include injections of 5-fluorouracil (5-FU) or bleomycin, both of which can help flatten keloids by disrupting fibroblast activity. These injections are often used when other treatments have not been successful.
Preventing Keloid Recurrence
Keloids have a notable tendency to recur even after successful treatment, making long-term management a significant challenge. The concept of “fast” removal often refers to the initial reduction in size or appearance, but sustained results typically require ongoing effort and vigilance. Effective prevention strategies commonly involve combination therapies, where multiple treatment modalities are used together to address the complex nature of keloid formation.
For instance, surgical removal is frequently followed by radiation therapy or a series of corticosteroid injections to suppress scar regrowth. Continued application of pressure dressings or silicone sheets after treatment can also help maintain scar flatness and prevent recurrence. Adherence to post-treatment protocols and consistent long-term follow-up with a dermatologist are important for monitoring the treated area and intervening promptly if signs of recurrence appear.