Skin Keloid Treatment Options

Keloid Before and After Photos

Most patients with keloid scars are concerned about cosmetic appearance but some have complains of pain, burning sensation and limited mobility. It is important to understand that the scar cannot be removed completely. However, the overgrowth of the scar tissue may be reduced and the appearance of the scar may be improved by minimizing its prominence. Maximum improvement may require more than one procedure or a combination of several therapies. It is important to discuss expected outcomes of the therapy and possible risks of each treatment with a physician or a surgeon.

Keloid Excisional Surgery
Keloids may be treated by excisional surgery, which removes the keloid entirely. The excision damages the least amount of soft tissue to minimize the trauma. The scar tissue is removed completely and adjacent healthy skin is moved to close the incision. The surgery is planned to minimize any skin tension created during the wound healing. If the incision is too large, a skin graft may be used. This procedure involves taking a section of skin tissue from one area and attaching it to another. The incision is closed with fine stitches resulting in a less prominent scar. Great care is taken to remove any sources of post operative inflammation and prevent secondary infection.

Some temporary discomfort, bruising, redness and swelling may be expected after the surgery. General postoperative recommendations include decreased activity, cold compresses to reduce swelling and avoiding stress to the area of the incision and healing. It is important to remember that to achieve maximum improved results the recovering process may take several months for complete healing.

Even with the surgery that removes the keloid entirely, the chances are high that the overgrowth may reoccur if no further treatment is used. External radiation, pressure therapy or cortisone injections are often combined with the surgery to optimize the results of the treatment.

Keloid Radiation Therapy
Radiotherapy is aimed to decrease fibroblast growth and collagen production in order to reduce the appearance of the keloid. The therapy may be combined with surgical excisions to achieve better cosmetic results and prevent recurrence of keloids. The results vary from good to excellent with the lowest recurrence rate of less then 10% among keloid therapies.

It has been noted that postoperative radiation therapy is as effective as a combination of preoperative and postoperative radiation. However, the therapy is most beneficial in the first two weeks following the surgical removal of the keloid when the fibroblasts undergo most of their growth and division.

X-ray and electron beam irradiation methods are most commonly used in keloid radiotherapy. While the X-ray orthovoltage radiation is more penetrating and may be more affective, electron beam radiation provides less stress to the surrounding organs and better dose distribution in tissues. Small-dose irradiation usually begins on the day of the surgery and is repeated 3 or 4 times. A typical treatment includes 3Gy every other day for 4 days or 5Gy every day for 3 days for the total dosage range of 9 to 16Gy.

Side effects are very moderate and may include hyperpigmentation and dermatitis. There is a potential of inducing neoplasia of salivary and thyroid glands, however, no malignances have been reported following the keloid radiotherapy. Shielding techniques are used to eliminate such occurrences. Children should not be subjected to radiotherapy unless no other option seams viable.

Mechanical Compression
Light mechanical compression of 5-25 mm Hg over the area of the filled wound has been shown to decrease the chances of keloid reappearance. Mechanical compression dressings are often custom made and are usually worn 24 hours a day for a few months but may be kept on for up to a year until the scar is fully healed. Sometimes silicone sheets are applied for the same purpose. Although the exact mode of action is not fully understood, it has been suggested that the compression leads to reduced oxygen tension in the small superficial vessels of the scar. Such an effect slows down metabolism in the scar tissue and inhibits collagen production leading to a reduction of the keloid size.

The therapy is especially successful in treating keloids on pierced earlobes. Small button-shaped compression devices are worn on the earlobes following the keloid excision surgery. Side effects may include some discomfort and mild rash, which disappears after an interval of a few days. The compression therapy is not applicable for treating head and neck keloids.

Corticosteroids
Another therapy in keloid treatment includes corticosteroid injections. Cortisone injections are a safe and not very painful method of treating keloids that may be used as a sole treatment or more effectively in combination with other therapies such as surgery. The steroid injections decrease collagen synthesis and minimize the thickening of the scar tissue.

Very little steroid (10-40 mg/ml) is injected into the fresh site of the scar incision every 4 to 6 weeks until the scar is flattened. Usual course of treatment includes excisional surgery combined with cortisone injections (Kenalog) after the surgery and every 6 weeks for 6 months. Treatment combining the surgery with steroid therapy increases the rate of successful keloid elimination to 85-100% and is considered one of the most effective keloid treatments.

Some side effects of steroid injections may include atrophy of skin or deeper tissues and formation of white steroid deposit spots. These side effects can be avoided by administering the lowest possible dose of the steroid. The injections can make the scar look reddish due to formation of superficial capillaries, which may be reduced in appearance by laser removal of the topmost layer of the skin.

Other Medical Therapies

Cryosurgery uses liquid nitrogen to locally freeze the scar tissue and cut the circulation and oxygen supply to it. This results in a slough of top skin layer leaving a keloid with re-epithalization. Depigmentation of the skin may be a side effect of the cryosurgery. The treatment is mostly effective for small keloids on lightly pigmented skin and in combination with cortisone therapy.

Laser therapy produces a precise external peel but often does not penetrate the keloid deep enough to remove the bulk of the scar tissue. This therapy may also reduce collagen production at the affected site.

Interferon therapy is one of the newest methods in keloid treatment. Interferons are proteins produced by our bodies as a part of immune response to viral infections and other immune challenges. Intralesional injections of the protein or topical applications that promote local interferon production have been shown to reduce collagen synthesis and promote its degradation in pre- and postoperative keloids. However, it has not been shown if the results are lasting.

5-Fluoracil injections have been used for treatment of small keloids. Fluoracil is a chemotherapy agent that interferes with cell division to slow down or stop cell growth, leading to a reduction in the size of the keloid.

Prevention of Keloid Recurrence
People with history of keloids should take care in prevention of the scar formation. Before any surgical procedure, patients should discuss with a physician their family histories of abnormal scar developments and any prior keloids. To prevent keloid formation, persons who have had this condition should avoid any elective skin surgeries such as piercing.

___________________________________________________________

Skin Keloid Before and After Photos
Skin Keloid Related Links/Related research

________________________________________

The Aesthetic Institute of New York and New Jersey is a facial Cosmetic surgery center dedicated to offering the latest and most innovative procedures in facial Cosmetic surgery.

The Aesthetic Institute of New York and New Jersey also provides educational material, lectures and online videos on facial Cosmetic surgery. We invite you to email us or call us for more information on the procedures we perform or information on our upcoming educational events.

Dr. Oleh Slupchynskyj is Double Board Certified in Facial Plastic and Reconstructive Surgery and in Otolaryngology – Head and Neck Surgery. He is also a clinical instructor of Facial Plastic Surgery at the New York Eye and Ear Infirmary, St. Vincent’s Hospital has affiliations with St. Barnabas Hospital in NJ. An independent health consumer council recently voted him one of Americas Top Surgeons.Learn more about Dr. Slupchynskyj