Keloid scar treatment can be extremely difficult, as there is no single approach that works in all cases. Methods of keloid scar treatment a doctor may attempt include steroids, surgery, and radiation. For some patients, none of these methods work, and effective treatment may simply not be possible.
What Is a Keloid?
A keloid is a scar that is caused by increased tissue formation after some type of trauma to the skin. When the skin heals, there can be an overproduction of collagen to cover the injured area. Eventually, the excess of collagen builds up into an unsightly red or purplish mass, known as a keloid scar. In addition to being unattractive, it can also itch severely or even be painful. Almost half of all people who experience this type of scarring do so on the earlobes as a reaction to piercing.
Keloid scarring is hereditary, so those who have family members with keloids are more susceptible to scarring in a similar manner. People with darker skin tone are also more likely to develop them, although it is not known why.
Health care providers can inject steroid drugs into the skin around the keloid in an attempt to treat it. Although steroids have been successful in many cases, they do not work for everyone, and tend to work best on smaller scars. Patients with darker skin can suffer from tissue atrophy or hypopigmentation — the loss of skin color — with this method. Keloid scar treatment using steroids also requires the patient to visit a medical professional multiple times for injections of steroids like hydrocortizone or triamcinolone, which are given every two to three weeks.
Surgery and Radiation Therapy
Excision, the surgical removal of all the scar tissue with a scalpel and local anesthetic, is also a viable method of keloid scar treatment. Removing the scars in this way does not always work, however, and in some cases, the keloid grows back later on. If this happens, there is a risk that it will be worse than before. Surgical excision alone has an average success rate of 65%.
In order to increase this success rate, radiation can be used with surgery as a last resort. In most cases, the area is treated with an external beam after surgery, which can damage the cells and may help prevent them from forming another keloid. Radiation is typically only used in cases where the scar is disfiguring and strongly resistant to every other treatment. The additional risk of cancer is a very important consideration before agreeing to this approach.
Other Medical Options
Some physicians prefer other treatment methods such as cryosurgery, which involves applying liquid nitrogen to the scar in order to destroy the abnormal tissue. As with excision, it is not unusual for the scar to eventually grow back later on; it also may cause it to darken in color. On the other end of the spectrum, there has been some success with the use of lasers to decrease the size of the keloid and improve its color. Another approach is interferon protein injections, which tend to shrink the scars. All of these methods show some promise, but there is not enough data to fully evaluate them, and insurance policies are less likely to cover them.
Many people claim to have had luck with homeopathic remedies such as topically applying tea tree oil or compounds rich in vitamin E. Silicone and compression bandages are said to be helpful in reducing the size of keloid scars, but are unlikely to get rid of them completely. There are also a number of treatment products that are sold over-the-counter and online, but few are strongly supported by scientific studies.
Even in the best of cases, treating keloid scarring can be a slow and frustrating experience. New treatments are constantly in development, but there are no definitive cure-alls currently available. When treating keloids, doctors often hesitate to use surgery, because of the chance of re-occurrence. Indeed, if a person is highly susceptible to experiencing keloids, as some tend to be, then the best treatment may be to not treat the area at all.