Keloid Scar Removal
What are Keloids?
Keloids form as a result of excess of collagen and 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.
What Causes Keloids?
The exact cause of keloid formation is unknown. There appears to be a loss of the normal mechanism between tissue repair and regeneration. Keloids are more common in areas that experience higher skin tension. These include the chest, neck and shoulders.
Factors that increase the risk of keloids include prolonged healing, chronic inflammation (e.g. acne) and repeated skin trauma (e.g. ear piercings).
You are at increased risk of keloids if there is a family member with keloids, you have had keloids before and if you are of darker skin colour.
Keloids can also occur spontaneously even if there are no apparent risk factors.
What Do Keloids Look Like?
Keloids take on different shapes and sizes. They can range from less a centimetre to several centimetres in length. They are firm to touch, but can soften after treatment. Although they are usually pink to purple in colour, they can get get hyperpigmented or hypopigmented (after steroid treatments).
Keloids may be symptomatic, causing itchiness, discomfort and a tight sensation. Besides being cosmetically unpleasant, symptomatic keloids may affect an individual’s quality of life.
How Are Keloids Diagnosed?
Keloids are diagnosed based on the clinical history and appearance on examination.
How Do You Prevent Keloids?
If you have risk factors of developing keloids, you should avoid unnecessary piercings, tattoos and surgery.
One of the most common causes of keloids is due to chronic acne vulgaris in Asian skin type. Therefore, it is essential to treat your acne early to prevent keloids for occuring in the first place.
Keloid Scar Removal Treatment Options:
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.
Common keloid scar removal treatments include silicon gel sheets, applying compression to the scar, and steroid 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.
More advanced keloid scar removal options include :
- Cryotherapy: Freezing the keloids may help to flatten it but it’s very painful.
- Pulsed Dye Laser: to reduce the redness associated with the keloid
- Injection: Bleomycin, Verapamil, Hyaluronic acid, Hyaluronidase and Botulinum toxin injection
- Fractional Carbon Dioxide Laser
- Surgery excision: This option will usually result in a larger keloid scar unless it is combined with injection steroids, radiation etc.
Steroid Injections for Keloids
Steroid injections for keloid scars removal is a well established treatment modality for keloids. It reduces abnormal collagen synthesis and inflammation during the wound healing process.
Individuals usually need repeated treatments spaced 4-6 weeks apart if keloids are especially recurrent and symptomatic.
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 are usually needed.
Combination: Steroid Injections and 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 steroid 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 4-6 weeks apart for the skin to heal, and you may notice the effects as soon as 2 weeks after your first treatment.
A topical anaesthetic cream is used prior to your treatment to maximise your comfort. Small, gentle and precise injections are delivered to the keloid scars. The procedure is tolerable for most individuals.
Side effects of steroids injections include:
- Skin or underlying Fat Thinning
- Skin blood vessels becoming more apparent
- Pigmentation changes to the skin.
- Skin denting inwards (may be permanent)
You will only feel a mild snapping or rubber band like sensation on the skin.
After your treatment, you will experience some swelling, redness and itchiness on the treated area. This will subside over the coming days. Within weeks, you should see an improvement in size and colour of your keloids.
- 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.
- Limmer, E.E., Glass, D.A. A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches. Dermatol Ther (Heidelb) 10, 931–948 (2020). https://doi.org/10.1007/s13555-020-00427-2