Cryosurgical media like liquid nitrogen affects the microvasculature and causes cell damage via intracellular crystals, leading to tissue anoxia. Generally, 1, 2, or 3 freezethaw cycles lasting seconds each are used for the desired effect. Cryotherapy can cause pain and permanent depigmentation in selected patients. As a single modality, cryosurgery led to total resolution with no recurrences in 51-74% of patients after 30 months of follow up observation.
Steroids are injected directly into the scar tissue to help decrease the itching, redness, and burning sensations that these scars may produce. Sometimes, the injections help to actually decrease the size of the scar.
Keloids are common among young black women who have had their ears pierced. Surgical cure rates are much poorer for the keloid scar than for both the widespread scar and the hypertrophic scar. The response to treatment also varies markedly by the anatomical location and from patient to patient. Large keloids of the anterior chest and posterior scalp will often form draining sinus tracts with multiple large, terminal hairs trapped within.
Moreover, no curative treatment exists for persons with genetic susceptibility to keloids. In general, the type and success of treatment depends on the keloid’s location, size, and thickness. Keloids are caused by a wounding of the skin, which can be caused by anything from an accident to surgery, acne, tattoos, or body piercings. are not true neoplasms but are an exaggerated reaction to trauma. Keloids are morphologically similar to hypertrophic scar and represent one extreme of the spectrum of reparative skin reactions.
If a patient has severe keloids with infected areas or scar contractures, surgery should be performed . If the keloids are too large to be removed in their entirety, the surgeon can resect the region of contracture or infection.
They should only be treated by a specialist doctor such as a dermatologist or a plastic surgeon. The growth is usually slow but occasionally there is rapid enlargement over a few months. Once they stop growing most keloid scars remain the same size or get smaller. In a keloid scar too much collagen is laid down in the skin after the damage has happened. Keloids can be difficult to treat, because of the risk of a new keloid developing in the treated area.
Excision of at least the immediate surrounding tissue is usually necessary, but these patients may respond to a short course of oral antibiotics. Keloids of the mid-chest often pull breast or adipose tissue towards the center of the chest creating the sensation of tightness as well as creating the appearance of cleavage. These lesions need not be fully removed to alleviate the dysfunction. Portions of the lesions tethering the skin can be excised to improve mobility, or high-dose corticosteroid injections can be used to intentionally cause atrophy with resultant skin relaxation. A keloid is a sharply elevated, irregularly shaped, progressively enlarging scar caused by excessive collagen in the dermis during connective tissue repair.
If you have a history of forming keloids and are having surgery, discuss with your surgeon any strategies to prevent keloid formation. Also, those with a tendency to form keloids may want to avoid any unnescessary piercings or surgeries. A mainstay for both treatment and prevention is the injection of steroids such as triamcinolone directly into the scar. Steroids help prevent inflammation and promote the breakdown of collagen. This helps to make scars less raised, and to decrease pain and tenderness associated with the scar.
The resulting defects can then be covered by a regional/local flap. Surgery should also be performed if the keloid growth causes significant deformity and the keloid does not respond to nonsurgical therapies. An example of severely deforming earlobe keloids is shown in Figure 4. Pressure therapy involves a type of pressure appliance worn over the area of the scar. These may be worn day and night for up to four to six months.
Differential diagnosis is important, since treatment a procedure differs between these two types of scar disorders. The (Table-1) and below didactically describes the clinical differences between them . Many patients ask for their keloid scar to be ‘cut out’ . This is hardly ever successful and in fact can result in an even bigger keloid scar coming back. Keloids must never be cut out by a GP or by anyone who isn’t medically qualified.
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. The main differential diagnosis of keloid is hypertrophic scar, also called pseudokeloid.