Keloid - Treatment and prevention

How can a keloid scar be treated?

Many patients ask for their keloid scar to be 'cut out' (surgically excised). This is hardly ever successful and in fact can result in an even bigger keloid scar coming back. Keloids must never be cut out by a GP or by anyone who isn't medically qualified. They should only be treated by a specialist doctor such as a dermatologist or a plastic surgeon.

Even then, most doctors will be very guarded in what they promise: how well a keloid scar responds to treatment can be unpredictable; many treatments are a matter of trial and error.

There are several ways of treating keloid scars, without surgery:

• One of the most common methods is injecting steroids and local anaesthetic into the keloid scar itself. The injections are done with a tiny needle, but can be a bit sore. This is called 'intralesional corticosteroid treatment':
• The steroids and anaesthetic can help to stop the proliferation of the skin cells in the keloid scar (what are called fibroblasts).
• Approximately one injection is given a month, for 4-6 months.
• One of the side-effects of too many steroids in the skin can be that the skin gets thin and easily damaged.
• Another treatment is silicone: it is put on to the skin either as a gel or a flexible sheet. Silicone treatment for skin damage has been used since the 1980s. But their use for keloid scars has not really been proven:
• They can reduce the thickness of the keloid scar.
• They can also make the colour paler.
• However, the silicone sheet can be cumbersome to keep on for long periods of time and also can look unsightly.
• The silicone gel is almost invisible once it's dry and is easy to apply. However, it can take a while to dry fully and you can't put any clothes on top until it's completely dry.
• Sometimes putting steroid ointment on, under a dressing, can dampen down a keloid scar. A tape that is impregnated with steroids is prescribed by dermatologists. They are helpful in children, who may not be able to tolerate steroid injections.
• Laser therapy has been shown to be effective for keloid scars. These are specialised treatments used by specially trained dermatologists. You should not use a cosmetic skin clinic that does not have properly qualified doctors.
• There are other treatments that are used rarely: radiotherapy or forms of chemotherapy that are injected into a scar. These are emerging treatments that are not commonly used.

This image shows a keloid around a Caribbean woman's ear that came back after surgery (a and b), followed by repeat surgery (c) and then repeated steroid injections (d):

Images from Openi® (Open Access Biomedical Image Search Engine)

Can keloid scars be prevented?

Once someone has had a keloid scar, it is vital they avoid piercings, tattoos and ideally any surgery unless essential. Steer clear too of unnecessary procedures such as cosmetic surgery, especially in those areas of the body where keloid is prone to develop. If you get acne, you should make sure it is treated effectively at an early stage so the spots do not scar. If you are identified as being at risk of keloid and need an operation, your surgeon may offer you dressings, steroid injections or other treatments to reduce the risk of keloid developing.