Keloids are thick scars that form after injury or trauma, but can also occur on their own. They can happen anywhere on the body but are common on the earlobes and trunk. Any form of injury to the skin, including surgery, ear/body piercing, accidental injury, or a tattoo can cause a keloid.Keloids tend to exhibit continuous growth.True keloid scars behave more like tumors and often continue to grow even years after the initial trauma to the skin.
Keloids are notoriously difficult to treat. It is important to work with a physician who has significant experience with Keloids - as in this case experience matters greatly. Treatment options can involve any of the following (and also involve combinations of the therapies listed below).
Steroid injections: With smaller keloids, this can completely resolve the keloid. With larger keloids, steroids are used to soften the keloid, decrease the amount to be removed, prepare the area for excision, and hopefully prevent recurrence after excision.It is often helpful for small keloids or to prevent keloids after surgery. Kenalog injections decrease the collagen response and help improve the chances of keloids from returning. These usually need to be repeated monthly for 3-4 months.These should only be considered in consultation with a dermatologist or plastic surgeon who is familiar with keloid treatment.
Pressure clip earrings- Pressure on the ears is thought to decrease the collagen injections and decrease tissue metabolism. The use of pressure earrings is recommended following excision of earlobe keloids to further decrease the risk of keloid recurrence.
Silicone sheeting- Unknown mechanism of action but thought to place a negative charge on the scar to improve keloid response.
5 FU injection- Can be used if above is not effective.
Excision: While the mechanism for steroid formation is not fully understood wounds that have issues with contamination or infection may be at higher risk for keloid formation. Excising the keloid with a meticulous closure can effectively treat even keloids that have recurred.For larger keloids, excision must be undertaken. In addition to excision, another treatment must be performed to decrease the chance for recurrence. Without another treatment, there is almost a 100% recurrence rate for keloids after surgical excision.
Radiation: For extremely resistant or disfiguring keloids radiation therapy can be an effective mechanism to reduce recurrency rates in combination with surgical excision. This should be reserved for severe or recurrent cases not amenable to other treatments. Radiation therapy does have long term risk of cancer.
Topical or Injectable medications: There are several medications which have been tried to decrease recurrence. These include the steroids, mentioned above, several chemotherapy agents, and a topical medicine called Imiquimod.
Surgery is also often used on the earlobe to debulk or remove the keloid. The recurrence rate can be high, so it is important to inject the keloid monthly after surgery.Surgical excision- In some cases the keloid must be excised because other therapies are not effective. Surgery alone is rarely effective in managing keloids
Steroid treatment usually requires multiple treatments. No singular treatment works best. If the keloid is large enough this can leave excess skin after successful treatment. Surgical excision alone has resulted in documented recurrence rates of 50 to 80%. However, excision of the keloid followed by Radiation therapy has been shown to reduce the recurrence rate to 20%. It is suggested that irradiation be initiated within 24 hours of the excision.
Depending on the size of the keloid, surgery may be first part. Then adding steroid injections and compression to the regimen will further reduce the recurrence rate. To further minimize the chance of the keloid coming back, you may even consider radiation therapy.
For individuals prone to keloid formation, having the keloid excised and injected postoperatively may prevent recurrence of the keloid. If the keloid does re-curr, consult a radiotherapist in your are that does this superficial radiotherapy- it can reduce recurrence by more than 80%.
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