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Keloids

What is a keloid?

Keloid is a type of scar which is firm, rubbery , fibrous nodule and can vary from pink to flesh-coloured or red to dark brown in colour. A keloid depending on its maturity, is composed of mainly either type III (early) or type I (late)collagen. It is a result of an overgrowth of granulation tissue (collagen type III) at the site of a healed skin injury which is then slowly replaced by collagen type I. A keloid scar is benign, non-contagious, and sometimes accompanied by severe itchiness, sharp pains, and changes in texture.

Are hypertrophic scars different from keloids?

Keloids should not be confused with hypertrophic scars, which are raised scars that do not grow beyond the boundaries of the original wound. Keloids expand in claw-like growths over normal skin. They have the capability to hurt with a needle-like pain or to itch without warning, although the degree of sensation varies from patient to patient.

Where do keloids appear?

Keloids can develop in any place that an abrasion has occurred. They can be the result of acne, insect bites, scratching, burns, or other skin trauma. Keloid scars can develop after surgery. They are more common in some sites such as central chest, the back and shoulders and the ear lobes.

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Treatment:

There are different treatment options available for keloids however no treatment for keloids is considered to be 100% effective.

Silicon sheets - One clinically proven and drug free scar treatment option is silicone sheeting. Silicone sheeting is safe and effective in reducing existing scars and helping to prevent new scars in anyone age 3 years and up. Other options are creams or gels that contain onion extract with allantoin which are available over the counter. These applications on keloid scars regulates and/or decreases dermal fibroblast proliferation and excess collagen production and thus prevents and reduces keloid scars and hyperthropic scars. These types of topical products are indicated for the treatment of all post traumatic (burns, acne, piercings) or post surgery scars and keloids. Treatment is simple but requires persistence. The earlier the initiation of treatment, the better the prognosis. 

Steroid injections - Steroid injections are best used as the scar begins to thicken or if the person is a known keloid former. A series of 3-4 injections with triamcinolone acetonide (10mg or 40mg/ml) are given every 3-4 weeks. The fibrosis reduces which is evident in the form of softness of the lesion ,reduction of size and flattening .

Newer uses of Botulinium toxin - Recent International studies have documented use of Botulinium toxin in Keloids and Scars. It can be used alone or with steroid injections.It has been found that , if perilesional botulinium toxin is injected at the time of injecting steroid there is faster improvement and sustained result in case of keloids.

Cryosurgery - Cryosurgery is an excellent treatment for keloids which are small and occur on lightly pigmented skin. It is often combined with monthly cortisone injections. It freezes the skin and causes sludging of the circulation beneath, effectively creating an area of localized frostbite. There is a slough of skin and keloid with renewed skin surface.

Compression — Compression bandages applied to the site over several months, sometimes for as long as six to twelve months, may lead to a reduction in the size of the keloid. Silicone Scar Sheets may be used safely under compression garments to aid in preventing new scars.

Radiation therapy — Electron beam radiation can be used at levels which do not penetrate the body deeply enough to affect internal organs.. Radiation treatments reduce scar formation if they are used soon after a surgery while the surgical wound is healing. 

Surgery - Surgery requires great care during and after the operation. Keloids that return after being excised may be larger than the original. There is a 50% chance of recurrence after surgical removal. However, keloids are less likely to return if surgical removal is combined with other treatments. Surgical or laser excision may be followed by intralesional injections of a corticosteroid and/or coverage with a silicone scar sheet such.Plastic closure of the skin including techniques such as v-plasty or w-plasty to reduce skin tension are also known to reduce recurrence of keloids following excision.

Laser therapy — This is an alternative to conventional surgery for keloid removal. Lasers produce a superficial peel but often do not reduce the bulk of the keloid. The use of dye-tuned lasers has not shown better results than that of cold lasers. A relatively new approach is to combine laser therapy with steroid injections and the use of Silicone Sheeting.

Newer treatments — Drugs that are used to treat autoimmune diseases or cancer have shown promise. These include alpha-interferon, 5-fluorouracil and bleomycin. However, there is a need for further study and evaluation of this treatment technique.

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