Keloid FAQ & Treatments
At OC MedDerm you can see our dermatologists for any type of bump or lump on your skin. Your medical issue will be thoroughly diagnosed and you will be informed about various treatment options. One of our core competencies at our office is diagnosis and treatment of keloids.
The above are before and after photos of one of our patients who developed a keloid scar after thyroid surgery. After just 3 treatments with injected steroids, the keloid was flattened and resolved permanently.
What is a Keloid?
Keloids (from a Greek word meaning “crab’s claw”) are overgrowths of scar tissue that occur after an injury to the skin.
What type of injury can cause keloids?
Any type of injury to the skin has the potential of causing keloid formation. This includes: surgical incisions, burns, traumas, piercings, tattoos, and even acne.
Is every scar overgrowth a keloid?
No. Hypertrophic scars are also a form of scar overgrowths. What distinguishes the two is a keloid extends beyond the original area of skin injury, whereas hypertrophic scars remain confined within the boundaries of the area of injury.
What is the time frame of scar growth?
Hypertrophic scars usually develop 2 to 6 month after the initial skin injury and tend to regress 18 to 24 months later. They may also be associated with pain, itching, and functional limitation. Keloids can occur months to years after skin injury with no tendency to regress on their own.
Can keloids shrink or resolve spontaneously?
Typically keloids remain the same size or continue to grow, in contrast with hypertrophic scars that tend to regress spontaneously over time and are asymptomatic.
What causes keloids?
There tends to be genetic susceptibility for certain individuals to develop keloids. Genetic susceptibility in combination with injury to the skin will lead to keloid formation.
Locations prone to keloid formation
Certain locations tend to be more prone to keloid formation. These locations include: upper back, shoulders, mid-chest, jawline, and ears.
Can keloids be symptomatic?
Yes, keloids can be painful, itchy, or sensitive to touch.
How can I prevent keloid?
Best prevention is to avoid trauma to the skin. If you have personal or family history of keloids, it is important to let your doctors know prior to any surgeries or invasive procedures. If you feel like a keloid scar may be forming, it is important to treat promptly to prevent further growth.
Can other more serious skin conditions look like keloids?
There are various serious diagnoses (such as sarcomas or deep fungal infections) that may present similar to keloids. At our OC MedDerm, our dermatologists are trained to make clinical diagnoses through clinical history and physical exam. If diagnosis of keloid is in doubt, a small skin biopsy will be performed to confirm the diagnosis before starting a treatment plan.
Our goal with keloid treatment
Many of our patients seek medical attention to relieve keloid related symptoms such as itching, pain, sensitivity, or functional impairment. Another common goal in treatment is reduction in size or complete removal for cosmetic improvement.
What you must know before treatment!
- You must know that there is a high recurrence risk associated with all keloid treatment options
- Repeated treatment in an interval of every 4 to 6 weeks may be required for certain forms of keloid treatment
- Combination treatments may be necessary to achieve satisfactory results
What are the most common treatments for keloids?
The most common and first-line treatment for keloids is serial injections with intralesional kenalog directly into the keloid scar.
Are steroid injections painful?
Keloid masses are often tender or sensitive to touch and injections can be painful in general. We can mix the kenalog with anesthetics to help provide pain relief to locations that require multiple injections.
What are the risks with steroid injection?
The associated risks with intralesional steroid injection are thinning of the skin, discoloration, increased vascularities, or atrophy of the skin in the injected area. Our dermatologists are trained to use the proper dosage and amount of steroid per injection to decrease risks.
Cryotherapy for keloid treatment
Cryotherapy can also be performed by freezing the keloid with liquid nitrogen. The keloid will scab up as a result and fall off within 3 to 6 weeks after treatment. For larger, dome-shaped keloid lesions, intralesional cryotherapy can be performed to treat the keloid from the inside. This alternative procedure requires repeated treatments as well. Cryotherapy is often a good option to be combined with surgical removal of keloids.
Why not just cut off the keloid?
We try to avoid surgical excisions of keloids due to the high recurrence rate of keloids at the site of surgery (due to skin injury). In certain cases surgery may be an option, but should be combined with preventive treatments to decrease risk of keloid recurrence.
Surgical excision of keloids
If the keloid mass is too large, failed consevative treatment, or shaped in a way that is more amenable to surgery, then surgical removal of the keloid may be an option. Close follow up after surgery is essential to prevent recurrence. Your dermatologist will provide you with a preventative treatment regimen if your keloids are treated with surgical excision.
Treatment with silicone gel sheet?
Silicone gel sheeting and fluid silicone gel are used in conjunction with other keloid treatment modalities to prevent initial growth or recurrence of keloids. When you are treated for keloids at OC MedDerm, a treatment plan will be initiated in addition to thorough patient education.
Pressure therapy for keloids?
Pressure therapy is usually performed with pressure garments, bandages, and devices to create direct pressure over keloids. For certain locations and keloid types, your dermatologist may recommend use of pressure therapy in combination to your primary keloid treatment.
Laser therapy for keloids
Many different laser platforms can be used to treat keloids but this may be challenging. At OC MedDerm our dermatologists will have a thorough discussion regarding all treatment options including lasers if indicated in your particular case.