Scar Wars: Winning the Battle Against Keloids
By Dr. Joshua Fox
Time may heal the wound, but – for some of us – the scar that is left behind will not fade. When it comes to keloid scars, the opposite happens. These scars expand beyond the initial wound site. Their appearance can be a big problem, and they also can cause, pain, discomfort, and limit movement.
In normal cases, our body creates a scar to heal from a wound. But in the case of keloid scars, our body fails to turn off its cellular skin-repair processes. As a result, there is an overgrowth: shiny pink skin-colored or purple flesh that bubbles up, above and beyond the wound’s boundary. We’re still learning about the biological misfire that causes this uncontrolled growth.
In general, about ten percent of us are keloid prone, but those with darker skin are more susceptible, with as many as fifteen percent developing keloids. Genetics plays a role: Fifty percent of sufferers share the condition with other family members. Age is also a factor, with most patients developing the scars during their teens and 20s, often when they are actively growing. Pregnant women and athletes also seem to be more susceptible to this malady.
Keloids can be triggered by minimal skin damage: an injection, a piercing, a tattoo. The scar overgrowth may take place long after the initial wound has healed and may continue to grow over a period of time. They generally do not resolve on their own.
Keloids themselves are benign. But their appearance can be distressing and deforming. Also, they may be itchy, painful, and sensitive. And depending on their size and location, they may inhibit movement.
Because these scars are prone to reoccur if cut out, keloids present a complex dermatologic challenge. We need to help patients navigate the maze of treatment options so they feel empowered to make effective choices.
6 Recommendations Regarding Keloid Scars
1. Remain aware of how keloids form: Most keloid scars are triggered by some kind of skin damage. This is really important in terms of understanding treatment plans – and also regarding other life choices, like decisions about whether to get a piercing or a tattoo, for a person prone to this problem.
2. Take time to consider options: There are a range of treatments including lasers, steroidal and chemical injections, freezing procedures, and radiation techniques. It’s vital for patients to work with their doctors to understand which will be most effective for their own situation. Whether the scar is early- or late-stage, its size and location are all factors in customizing the most effective treatment plan. The treatment therapy also depends if they just want to eliminate the pain and itching, or if they want to completely remove the appearance of the keloid.
3. Understand the role of combination treatments: A combination of treatments can minimize the existing scar and also limit subsequent regrowth. Steroidal injections, for example, are often combined with cryotherapy, which applies freezing temperatures to minimize the scar. We may also add a cocktail to the injections including various types of steroids, anesthetics, and immunosuppressants to improve the results. And if surgery is warranted, additional treatment to prevent regrowth is required. The great effectiveness of pairing surgical removal with superficial radiation therapy.
4. Stay alert for treatment advances, such as Cryoshape™: The ‘Cryoshape™’ procedure involves freezing a keloid scar from the inside. This causes the scar tissue to die and eventually fall off. Also – importantly – the internal freezing appears to destroy abnormal keloid cells and inhibit regrowth. We’re seeing really good results. There are also new topical treatments many of which include silicone in either a liquid or patch form. Pressure and massage may also have a role in treatment.
5. Choose your doctor carefully: If not treated properly patients can end up with additional scarring or with a series of frustrating outcomes. Also, since research is ongoing and new treatments are emerging, it’s important that your doctor is on top of the most current techniques.
6. Take preventative steps to avoid additional scars: Keloid-prone patients should avoid unnecessary skin damage, like piercings and tattoos. If surgery is needed, patients should work with their doctor on a post-op plan to minimize scarring. In the case of skin injuries, the American Academy of Dermatology web site includes a list of self-care steps that can limit keloids.
The good news is our growing understanding of keloids is giving us improved techniques to help patients.
Joshua L. Fox, M.D., F.A.A.D., Medical Director at Advanced Dermatology PC. He is board certified and specializes in skin cancer, cosmetic surgery, and laser procedures.