A Dermatologist’s Guide to Dealing with Keloid Scars

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What are Keloids? 

Keloids are a type of dermal scar resulting from trauma, burns, and surgeries, (cosmetic surgeries such as piercings and tattoos are common causes in younger age groups). Keloids are oftentimes characterized by a coloured, hard, raised, nodule-like appearance, and can cause itchiness, discomfort, and pain, such as a  burning or a “pin-like” sensation. Keloids typically grow much larger than the original injury site, even if the original site of injury goes unnoticed; movement could become restricted if the presence of the keloid interferes with joint mobility. It is thus important to see a trained dermatologist in Singapore if you suspect you have a keloid scar.

Keloid scarring is common across all populations across the globe; however, the occurrence is more prevalent in women, individuals with darker skin tones, and those with a genetic predisposition to developing keloids—some individuals may experience a recurrence of keloids throughout their lives, and in varying degrees and locations. 

Keloid Symptoms 

Developing an at-home screening routine is conducive to monitoring your overall dermatological health. Although there are commonly reported symptoms of keloids, it is imperative to consult a dermatologist, who may perform a skin biopsy to rule out the presence of malignant tumours. 

Keloids differ from mature scars in size and composition and may take weeks to several months to fully develop; they may occur in areas of the chest, shoulders, back of the neck, jawline areas, earlobes, arms, and upper back. Although keloids may occur anywhere in which a type of trauma has been inflicted. 

Common symptoms of keloids are: 

  • A pink, red, or purple area localized around a point of injury 
  • A hard, nodule-like growth slowly growing and developing over time 
  • A lumpy or ridged area causing itchiness, burning, or discomfort 

While the appearance of a keloid could be initially alarming, keloids are benign and do not pose any additional physical health risks unless the location of the keloid is restricting joint mobility. The most common concern when dealing with keloids rely on cosmetic factors, and may affect your overall psychological well-being if your self-esteem is affected; it is important to explore all options with your dermatologist so that he or she may provide the service to you based upon your experience with keloids.

Keloid Treatment 

Determining the level of involvement with your dermatologist relies on your own concerns and expectations with the treatment process. In order to attain satisfaction with the treatment process of keloids you must be  willing to explore the following options: 

  • What do you hope to accomplish in treatment? Are pain, itchiness, and discomfort listed as your top concerns, or are you more concerned with the psychological aspects of the keloid—is your self-esteem compromised? 
  • Consider the appearance of the keloid: are you more concerned with flattening or softening your keloid? 
  • Are you willing to compromise body modifications? For example, are you willing to discontinue the use of your body jewellery? 

Communication is the most important aspect to consider when consulting your dermatologist; you must be willing to explore all options to determine which treatment plan is right for you. You must also discuss previous experiences with keloids, as well as genetic or familial history; modern biomedical research indicates keloid formation is highly influenced by the occurrence of complex epigenetic processes. 

Treatment Options for Keloids 

After your medical concerns and genetic history are documented by your dermatologist, he or she will outline a series of treatment options to begin treatment on your keloids. It is important to understand that some keloids may not completely disappear; however, treatment may be beneficial in altering the appearance of your keloid. Each method possesses individual benefits and drawbacks, all of which should be discussed when considering treatment with your dermatologist. 

Injections

Corticosteroids are the most prevalent form of injection when treating keloids; injections are taken a total of four times and dosed once every 20-30 days. Keloid shrinkage should slowly progress as treatment occurs, with a disappearance rate of 50-70% after completion of treatment; there is a chance for keloids to recur, so injections are best paired with alternative treatment methods. 

Surgical Excision

Complete removal of the keloid to prevent recurrence is typically an unsuccessful method of treatment. To achieve success with this method, your dermatologist may suggest radiation or cryotherapy. 

Radiation

Utilizing radiation after surgical excision is one of the most successful methods to prevent the recurrence of a keloid. 

Cryotherapy

A dermatologist might suggest utilizing cryotherapy if a keloid is small in size. Using cryotherapy minimizes the damage received below the keloid scar tissue via the surgical method. 

Laser Treatment

Laser treatment is a successful option when the presence of colour is an issue with keloids.  Not only does laser treatment reduce the visible colour of the keloid, but it can also shrink the size of the keloid when combined with injections or pressure. 

Compression earrings, dressings, and garments

Compression and pressure are about 90% effective after surgical treatment; however, using compression is a tedious and often painful process. Patients are advised to wear earrings or garments from 6-12 months and may experience pain due to pressure. 

Silicone gels or sheets

These sheets are applied and reapplied to the keloid; they are typically combined with pressure therapy. 

Ligature

Using a ligature to remove the keloid can also be a tedious process; your dermatologist will surgically tie a thread around the keloid, causing it to gradually fall off; the thread requires replacement every 2 weeks until the keloid successfully falls off. 

Alternative methods

Communication is the key factor when determining which treatment option is right for you; discussing alternative methods with your dermatologist is crucial if you are concerned with the side effects of the treatment, the financial cost of treatment or you are curious to explore homoeopathic remedies. As the medical community generates larger bodies of research involving the pathogenesis and treatment of keloids, more options may become widely available to public health services. 

What to expect post-treatment of keloids 

The success rate or the possibility for recurrence of your keloid is determined by the treatment plan selected by you and your dermatologist. It is important to reflect on the initial concerns regarding your keloid: has the appearance and colour improved? Has the pain, itchiness, or discomfort subsided? Maintaining open discussion with your dermatologist is crucial to the success rate of treatment. 

Your dermatologist may outline a comprehensive post-treatment plan for you depending on which treatment you have selected and where you may be in the healing process. It is important to abide by all guidelines, as per your dermatologist, to ensure the keloid does not recur. 

Can keloids be prevented? 

Outlining your genetic and familial history with keloids is important as to whether a keloid will initially occur; many genetic factors are responsible for the progression of a keloid scar. Keloids occur after a type of trauma is inflicted—burns, surgeries of varying degrees, piercings and tattoos are all common culprits in the formation of keloids. 

Prevention of the formation of keloids is reliant upon avoiding non-essential surgeries, piercings and tattoos, as well as utilizing pressurized body jewellery to prevent scarring if body modifications are desired. If surgical procedures are unavoidable, a mindful and cautious technique must be utilized by the practitioner to minimize the damage inflicted upon the tissues.