Currently, there is no completely effective way to treat keloids or to prevent their formation. Traditionally, surgical removal of the scars was recommended. People who are prone to keloids should avoid cosmetic surgery. When surgery is necessary in such people, doctors can take special precautions to minimize the formation of keloids at the site of the incision.
Notably, postoperative application of corticosteroid tape/plasters significantly prevents the development of keloids and hypertrophic scars after surgery. If the keloid scar is not responsive to nonsurgical management options, surgery may be performed. One type of surgery directly removes the scar formation with an incision, and stitches are placed to help close the wound.
For severe cases, the keloid can surgically excised and given x-ray treatments to the site immediately afterwards, usually the on the same day. Electron beam radiation can be used, which will not go deep enough to affect internal organs. Orthovoltage radiation is more penetrating and slightly more effective.
Keloids appear as firm, mildly tender, bosselated tumors with a shiny surface. The main differential diagnosis of keloid is hypertrophic scar, also called pseudokeloid, which not only a clinical challenges, but also histological challenge. No single therapeutic modality is best for all keloids. The location, size, and depth of the lesion; the age of the patient; and the past response to treatment determine the type of therapy used, so there are several options in keloid treatment. Prevention is the first rule in keloid therapy, so we must take special care in treating patients with a history of keloids.
This review gives a comprehensive view of keloid formation and this is the object of this review. A variety of treatments are available for the management of keloids.
Intralesional corticosteroid injection is the first-line therapy for most lesions. The majority of patients will improve with this therapy. If surgical excision is performed, adjuvant therapy is necessary to decrease the risk of recurrence.
Scars may be treated with a variety of different lasers, depending on the underlying cause of the scar. Lasers may be used to smooth a scar, remove the abnormal color of a scar, or flatten a scar. Most laser therapy for scars is done in conjunction with other treatments, including injections of steroids, use of special dressings, and the use of bandages. Multiple treatments may be required, regardless of the initial type of therapy.
There have not been any reports of this causing any form of cancer in many years of use, but it is very expensive. Silicone pads and creams are sold over the counter for use on keloids. These do benefit hypertrophic scars but will not cure a true keloid. However, they can reduce pain, swelling and itching from a keloid.
However, the downsides of corticosteroid injections include pain and difficulties associated with contraindications such as pregnancy, glaucoma, or Cushing’s disease. This problem can be overcome by using steroid tapes/plasters. Most pediatric and older patients can be treated by steroid tapes/plaster alone because they have much thinner skin, which means that the steroids are easily absorbed . Corticosteroid tape/plasters on their own or in combination with other therapies such as corticosteroid injection are also suitable for adults with minor keloids.
The carbon dioxide laser, the lasers used for vascular lesions and the pulsed dye laser have all been reported for treating keloids and hypertrophic scars. Corticosteroid injections rapidly reduce the volume of a scar .
Sometimes, skin grafts are used to help close the wound. This involves replacing or attaching skin to an area that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body and attaching it to the needed area.