Keloid Scar Removal
Keloid scar removal treatments are in constant refinement and development. Over the years, there have been new developments and insights into keloid scar removal. Choosing the right treatment depends on the size, location, depth of scar and age of the individual.
Keloids form as a result of excess of scar tissue during the healing phase. This can occur following skin trauma (burns, tattoo, ears piercing, cuts), infection and inflammation.
This abnormal wound healing process is more common in Chinese, Blacks and Hispanics and there may be a familial tendency to develop such scars.
The development of a keloid scar is not only cosmetically disfiguring, but may cause pain and itchiness to the individual. In some cases, the scar may be infected or even form an ulcer. The ears, chest, shoulders and upper arms are areas prone to forming keloids. Keloids may develop months to a year after injury, and do not resolve spontaneously.
What are Hypertrophic Scars?
Keloids develop and extend beyond the site of injury. They do not spontaneously disappear, and the extension of tissue outwards may resemble a crab claw.
On the other hand, Hypertrophic scars tend to be confined within the borders of the initial skin injury. They can disappear by themselves over time. However, they are frequently itchy, red and raised.
Keloid Scar Removal Treatments
Keloid scar removal remains a challenge, despite the varied treatment options. The type of treatment used will depend on factors such as age, size of the scar, thickness and location of the scar.
Standard treatments include silicon gel sheets, applying compression to the scar, and anti-inflammatory injections.
Silicone gel sheets and dressing work by occlusion, and providing hydration to the scar. However, they need to be worn almost 24 hours a day for up to one year! A variety of compression devices and materials have been used for individuals with keloids. This include bandages of various materials (e.g Lycra), and a variety of pressure garments. The pressure reduces the collagen bundles from sticking together, and improves scarring.
Advanced treatment options include cryotherapy, surgical excision, anti-inflammatory injections combined with lasers and various injectable agents. See below for details.
An excellent resource about keloids is provided by the British Association of Dermatologists here.
Anti-inflammatory injections is a well established treatment modality for keloids. It reduces abnormal collagen synthesis and inflammation during the wound healing process. Common terms used for steroid injections include Kenalog and cortisone injections. They contain the steroid by the name triamcinolone. We usually use the 10mg/ml concentration for hypertrophic scars, while the 40mg/ml concentration is reserved for thick keloid scars
Individuals usually need repeated treatments spaced 4-6 weeks apart for better appearance of the scar.
Side effects of anti-inflammatory injections include:
- Skin Thinning
- Skin blood vessels becoming more apparent
- Pigmentation changes to the skin.
- Skin denting inwards (may be permanent)
Pulsed Dye Laser
Pulsed dye laser with 585nm wavelength is an established treatment for Keloid and hypertrophic scars.
They work by reducing the blood vessel supply feeding the abnormal scar tissue. Pulse dye laser treatments reduces redness and size of the keloid scar.
Multiple treatment sessions will lead to greater scar improvement over time.
Botulinum Toxin Injections
There is emerging interest in the use of botulinum toxin. Botulinum toxin has been shown to alter the cell cycles of scar tissue in keloids. Botulinum toxin reduces skin tension during wound healing, and may reduce the appearance of keloids and hypertrophic scars.
Multiple treatments at 3 months interval showed good results in some studies. It also helped to reduce redness and itchiness associated with scarring.
Please note that botulinum toxin for Keloid and Hypertrophic scarring is for off-label use only.
Injection Steroids + Pulsed Dye Laser
A combined approach for keloid scar removal can easily be carried out in one visit.
One of the most effective options include anti-inflammatory injections to the keloid scar, followed by the use of the Pulsed Dye Laser. The former reduces the abnormal inflammatory response and scar formation, whereas the latter reduces blood supply to the scar. A combined approach has a synergistic effect, and reduces the total number of treatment sessions.
There is minimal discomfort during the procedure as a numbing cream is applied prior to the treatment. You can expect a gradual reduction in size and colour with repeated treatments. Usually treatments are spaced 4 weeks apart for the skin to heal, and you may notice the effects as soon as 2 weeks after your first treatment.
Where can I get more information:
- Hayashi T, Furukawa H, Oyama A, et al. A new uniform protocol of combined corticosteroid injections and ointment application reduces recurrence rates after surgical keloid/hypertrophic scar excision. Dermatol Surg. 2012 Jun. 38(6):893-7.
- Robinson AJ, Khadim MF, Khan K. Keloid scars and treatment with Botulinum Toxin Type A: the Belfast experience. J Plast Reconstr Aesthet Surg. 2013 Mar. 66(3):439-40.
- Zhibo X, Miaobo Z. Intralesional botulinum toxin type A injection as a new treatment measure for keloids. Plast Reconstr Surg. 2009 Nov. 124(5):275e-7e.
- Alster T. Laser scar revision: comparison study of 585-nm pulsed dye laser with and without intralesional corticosteroids. Dermatol Surg. 2003 Jan. 29(1):25-9.