Keloids result from abnormal wound healing in response to skin trauma or inflammation. The keloids extend beyond the boundaries of the original wound site, as opposed to the hypertrophic scars. They are mainly found in the ear lobes, shoulders, upper side of the back and chest. Keloids have no tendency to improve over time. They occur at the same frequency in both men and women, creating deformities that have significant cosmetic implications for affected patients.
Keloids are a consequence of uncontrolled synthesis and deposition of excess collagen at areas of prior injury. In every skin injury, healing process is activated to restore the tissue, both structurally and functionally, to its original state. In some cases, this mechanism is disrupted, resulting in either hyperplasia of the skin at the site of injury or incomplete healing. They can occur following surgery, piercings, acne, tattooing, insect bites, burns, lacerations, cryosurgery or vaccinations .
Therapeutically it is recommended:
- Cryotherapy: Use of cold nitrogen to degrade hypertrophic tissue through cell destruction.
- Intralesional injection of steroids & other Substances (bleomycin, botox, 5-fluorouracil): Injections are given once a month and inhibit proliferation of fibroblasts, reducing postoperative scarring.
- CO2 Fractional Laser: Distorted lesion is reshaped by the creation of new collagen and elastin, greatly improving their texture and color.
- Application of topical ointments and steroid impregnated tapes: Relief from severe itching symptoms and feeling of tension in areas of mild hypertrophic scarring and small keloids.
- Topical application of gel or silicone sheets in combination with local binding.
- Keloid Surgical Removal: It is usually avoided, as new trauma from surgical removal can again lead perhaps to larger Keloid. However, in some cases partial removal is needed to reduce volume and make it easier to apply one of the above treatments.
All treatments require multiple sessions and do not uniformly result in complete regression of keloid. The most successful treatment results from the use of multiple modalities which may include intralesional steroid injections, cryotherapy and topical steroids in order to meet patient’s needs.
