Keloid scars can affect anyone, but they’re more common in people with dark skin and it’s thought they may run in families. Experts do not fully understand what causes keloid scars, but they happen when there’s overproduction of collagen (the skin’s protein). Imiquimod induces local production of interferons at the site of application. It comes as a 5% cream and is started immediately after surgery and continued daily for 8 weeks. Patients with large surgical sites, flaps, grafts, or wounds closed with tension should not start imiquimod therapy for 4-6 weeks.
Keloid is an overgrowth of the scar tissue that develops around a wound, usually after the wound has healed. Rather than stay in a straight line, for example, after a surgical incision, it spreads outwards. A keloid is hypertrophied tissue that develops in an area of injury or spontaneously; keloids are shiny, smooth, often dome-shaped, and slightly pink. Other treatments that have been used for keloids include laser therapy, silicone sheets , and compression dressings.
We’re currently examining whether this drug can reduce such symptoms, and preliminary data are promising. Silicone sheets, which resemble bandages without the gauze pad, can be applied to new wounds to reduce the risk of developing a keloid. However, these special sheets do not reduce the size of existing keloids. Anti-inflammatory steroid injectionsadministered into a new scar can help reduce inflammation, which seems to play a role in keloid development.
Injections of fluorouracil, a compound used in cancer chemotherapy, has shown some efficacy in flattening small keloids. These treatments, especially surgery, sometimes cause the keloid scar to become larger. Laser therapy is now used to treat many types of skin problems, including keloids. It is often combined with steroid injections to give the best cosmetic result.
This is performed immediately after surgery by injecting 1 million U to each linear centimeter of the skin surrounding the postoperative site. INF-gamma injected weekly reduces the size and elevation of keloids, but the highest reduction obtained was 50% at 18 weeks. A randomized study by Mourad et al indicated that keloid therapy with intralesional cryotherapy is more effective and requires fewer treatments than the spray variety. The study included 50 patients, with a 6-month follow-up.
We can offer advanced treatments, including chemotherapy-based agents to kill cells that actively overproduce collagen. For patients with pain and itching, we can also offer pentoxifylline, an oral drug that is approved by the Food and Drug Administration to treat poor blood flow.
Treatment consisted of surgical excision with ear lobe reconstruction, steroid injection, and pressure therapy. Simple excisional surgery should involve the least amount of soft tissue handling to minimize trauma; also, plan the closure with minimal skin tension along relaxed skin tension lines.
Treatment options for keloids range from injections and cryotherapy to surgery and laser therapy. Aside from their characteristic visual appearance, keloids fortunately do not normally cause many other symptoms. A small proportion of patients may experience pain, itching, or burning in the scar tissue.
The major side effect is mild-to-marked irritation at the site of application. Often, therapy must be stopped for several days then restarted.