Keloid scars are an abnormal form of scarring that occur in some individuals.
They are more common in certain skin types such as Afro-Caribbean skin and they are also more common in certain areas such as the earlobes, the shoulders or over the breast bone.
They are raised lumpy scars which are often itchy and are darker in colour to the normal skin colour so they can be red or purple in Caucasian skin or darker brown in pigmented skin.
They are difficult to treat because it is an abnormal response by the body and we don’t really know why they occur.
There are five main forms of treatment for keloid scars:
1. Moisturising and Massage
If your scar is only slightly raised and particularly if it is within the first year then you may have a hypertrophic scar rather than a keloid scar and these tend to be less severe and more likely to improve over time.
Moisturising and massaging the scar will help it to soften and may help with the itch.
The next step would be to use silicone on the scar.
Silicone comes in 2 forms, a gel or a sheet.
Silicone sheets are useful on flat areas particularly underneath clothes because while the silicone sheets are sticky, they do not stay on well on exposed areas.
For keloid scars in exposed places like the face or the ears, silicone gel is more effective.
The silicone needs to stay on for 23 hours of the day and is only taken off to wash.
It can help with the red and raised nature of the scar and also the itch.
Pressure is known to improve the quality of keloid scars although it is dependent on the area as to whether it can be used as a modality for treatment.
Keloid scars on the earlobes may be amenable to having pressure applied by using a custom-made clip which will press on the scar and can help it to flatten.
Other areas of the body can be more difficult to apply pressure to although it may be possible to have a custom-made garment depending on the size and location of the scar.
For severe scarring of the face, a custom mask can be made to apply pressure, although this is only for extreme cases.
4. Steroid Injections
The next step for troublesome keloid scarring is to use steroid injections.
Steroids are used to dampen down inflammation and it is presumed that the cause of the keloid scarring is an inflammatory reaction within the scar.
The steroid needs to be injected into the scar itself and this can be uncomfortable.
Steroid injection is a procedure that can be performed in the outpatient clinic and may need to be repeated.
5. Excision Of Keloid Scars
One of the last options we consider, but perhaps one of the first options that many people think about, is excision of the scar.
It may seem an obvious choice to excise and give a fresh neat scar. However because keloid scarring is due to your body’s reaction to forming scars, there is a high probability that if a fresh scar was made, it could be keloid again and it could come back worse because the new scar would be longer than the original one.
Excision of a keloid scar is sometimes performed if it is a very large and bulky scar that is unlikely to be significantly reduced with steroid, pressure or silicone.
When excision of a keloid scar is considered, we would usually perform what is known as an intralesional excision of the scar which involves leaving a rim of keloid scar behind so that fresh skin is not cut into.
This leaves a residual lump which can then be treated with one of the other methods above such a steroid injection, pressure clips and silicone dressings or a combination.
The treatment of keloid scar is challenging and as you go up the ladder of increasingly invasive methods then the potential risks also increase.
This is an outline of what is available for keloid scars but each patient needs to be treated on a bespoke and personal level with a package or combination of treatments which will give the best possible outcome.
If you would like a consultation with one of our Plastic Surgeons for an assessment of your keloid scar then you can call us on 0121-454 3680, alternatively email us a photograph if you would like us to give you an opinion.
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For more information about scar revision, visit our scar revision page.