Types of 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.

How can I prevent keloid formation?

You can prevent keloid formation by avoiding skin injury 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 the return of acne. If you have acne, avoid shaving your neck and face as doing so may irritate your acne even more 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 you scar hidden from the sun for at least the first three months after an injury in order to avoid excessive darkening of the scar.

My keloids are painful and/or cosmetically unpleasing, how can I treat them?

There are numerous treatments:

• Intralesional (injected) corticosteroids
• Excision
• Silicone gel sheeting

• Cryosurgery
• Pressure earrings
• Radiation therapy
• Interferon alpha
• Laser therapy
• Injection of fluorouracil

A dermatologist 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.

What are intralesional corticosteroids?

Intralesional (injected) corticosteroids are usually the first type of therapy that is 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. Up to 70% of keloids flatten with this therapy.¹ Unfortunately, up to 50% of keloids return within 5 years.¹ If the keloid does not respond after four treatments, your dermatologist may recommend alternative therapy such as surgical removal, possibly in conjunction with another therapy.

What is a 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.

What is 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.

  At the moment, it is not clear how well silicone gel treats keloids.  However, silicone gel sheets may be tried for up to 6 months. They are available either by prescription or over-the-counter and should be cut to the size of keloid, placed and taped into place. The sheet should be washed daily and replaced every 10-14 days.

What is cryosurgery?

This refers to the use of liquid nitrogen, sprayed on to your keloid for 10-30 seconds, up to three times in a row. Such treatment sessions can be repeated every month until a response is achieved. This therapy 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.

What are pressure earrings?

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

What is 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. However, any radiation increases the risk of cancer and is therefore rarely recommended as a treatment for keloids, a benign disorder.

What is 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. However, it is not clear how effective this treatment really is based on current scientific evidence, and therefore is not often recommended.

What is 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. It may cause ulceration and up to half of patients have a recurrence within one year. This treatment may be combined with intralesional corticosteroid injections.

What is 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.