Prevention and Treatment for Keloids

A keloid is an abnormal scar that may also be itchy, painful, and spreads beyond the original borders of the skin injury. There are many ways to treat keloids, but if you know you are likely to form keloids, the most effective strategy is to prevent keloid formation in the first place.

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How to Prevent Keloid Formation

You can prevent keloid formation by avoiding skin injuries like:

• Cuts
• Surgery
• Body piercing
• Infection
• Acne

If you form keloids in response to acne, it is important to treat the acne quickly and use medications to help prevent its return. If you have acne, avoid shaving your neck and face, as doing so may irritate your acne and stimulate more keloid formation. Instead, use scissors to trim your facial hair. Keep the hairs at least one-eighth of an inch long.

Additionally, proper treatment of wounds may help minimize scar formation and, in turn, reduce keloid formation. Try to keep your wounds moist with petroleum jelly and covered with a non-stick bandage. Keep your scar hidden from the sun for at least the first three months after an injury to avoid excessive darkening of the scar.

Keloid Treatments

There are numerous treatments available for keloids:

• Intralesional (injected) corticosteroids
• Excision
• Silicone gel sheeting
• Cryosurgery
• Pressure earrings
• Radiation therapy
• Interferon alpha
• Laser therapy
• Injection of fluorouracil

A dermatologist, a facial plastic surgeon, or a plastic surgeon can recommend one or a combination of these treatments. It is important to note that keloids may return after treatment. Get your keloids treated as early as possible, since this increases the chance they will respond to treatment.

Intralesional Corticosteroids

Intralesional (injected) corticosteroids are usually the first type of therapy recommended for the treatment of keloids. A needle is used to inject a steroid, typically triamcinolone, directly into the keloid. Liquid nitrogen may be applied prior to injection. Injections are repeated every month until the keloid becomes flatter and softer. One study showed an 82.7% reduction in the size of the scar three months after the last injection. The treatment may be combined with other therapies for better results. 

Surgical Excision

In a surgical excision, a scalpel (a sharp surgical blade) is used to remove the keloid. Triamcinolone or another medication called interferon is often injected before, during, or after the excision. Injecting triamcinolone around the time of surgery helps prevent the keloid from returning.

Silicone Gel Sheeting

Silicone gel sheets are sticky clear sheets placed over scars. They allow oxygen to pass through and help maintain a moist environment to improve healing. They may help reduce pain or itching from keloids and prevent the growth of new or existing keloids. For optimal effectiveness, silicone gel sheets should be used for at least three months and at least four hours a day. They are available either by prescription or over-the-counter and should be cut to the size of keloid and taped into place. The sheet should be washed daily and replaced according to the manufacturer’s instructions.

Cryosurgery

This refers to the use of liquid nitrogen sprayed onto your keloid for two 15-second sessions. This therapy can be repeated up to six times and is often combined with other treatments. It is important to note that in patients with darker skin, the skin treated with liquid nitrogen may become lighter or darker.

Pressure Earrings

These are inexpensive earrings customized to you which compress your earlobe. They are worn over your earlobe immediately after piercing to prevent a keloid from forming.

Radiation Therapy

An external X-ray beam is applied to a keloid. Radiation therapy can prevent a keloid from re-growing after it was surgically removed in a majority of patients. Although any exposure to radiation increases the risk of cancer, the amount used in treating keloids is generally considered very safe. 

Interferon-Alpha

Interferon-alpha are proteins released by cells to help activate the immune system. They may be injected after a keloid is surgically removed in order to prevent recurrence. Although it is an expensive therapy, research suggests it may have promising effects, particularly on scars resistant to other forms of treatment.

Intralesional Fluorouracil

This is a chemotherapeutic drug injected into keloids. It treats keloids by blocking DNA replication. This stops fibroblasts, the cells that overgrow in a keloid, from reproducing. Some patients report ulceration and pain as side effects. This treatment may also be combined with intralesional corticosteroid injections.

Pulsed Dye Laser

A pulsed dye laser is a laser that has been shown to improve keloids and is especially helpful for reddish keloids and scars. Other lasers such as fractional lasers have also been used to treat keloids. Laser treatment can be performed in combination with intralesional injection of either corticosteroids or fluorouracil.