What is a keloid?
Keloids, sometimes referred to as a keloid scar, is a tough heaped-up scar that rises quite abruptly above the rest of the skin. It usually has a smooth top and a pinkish, reddish or maroon color. Keloids are irregularly shaped and tend to enlarge progressively. Unlike scars, keloids do not subside over time.
|Keloid scars are quite common after BCG injection|
What is the difference between a keloid and a hypertrophic scar?
After the skin is injured, the healing process usually leaves a flat scar. Sometimes the scar is hypertrophic, or thickened, but confined to the margin of the wound. Hypertrophic scars tend to be redder and may subside by themselves (a process which can take one year or more). Treatment such as injections of cortisone (steroids) can speed this process.
Keloids, by contrast, may start some time after the injury and extend beyond the wound site. This tendency to migrate into surrounding areas that weren't injured to begin with distinguishes keloids from hypertrophic scars. Keloids typically appear following surgery or injury, but they can also appear spontaneously or as a result of some slight inflammation, such as an pimple on the chest (even one that wasn't scratched). Other minor injuries that can trigger keloids are burns and piercings. BCG injections can also give rise to keloids.
What are the signs and symptoms of keloids?
Keloids are raised and look shiny and dome-shaped, ranging in color from pink to red. Some keloids become large and unsightly. Aside from causing potential cosmetic problems, these scars tend to be itchy or even painful to touch.
What is the cause of keloids?
Doctors do not understand exactly why keloids form in certain people or situations and not in others. Changes in the cellular signals that control growth and proliferation may be related to the process of keloid formation, but these changes have not yet been characterized scientifically. You may have a genetic tendency to form keloids if you are prone to it.
|Keloids develop most often on the chest, back, shoulders, and earlobes. They rarely develop on the face (with the exception of the jawline).|
Which people are most susceptible to keloids?
Keloids are equally common in women and men, although at least in times past more women developed them because of a greater degree of earlobe and body piercing among women. Keloids are less common in children and the elderly. Although people with darker skin are more likely to develop them, keloids can occur in people of all skin types. In some cases, the tendency to form keloids seems to run in families. Asians are more prone to keloids than Caucasians.
In which area of the body are keloids most likely to appear?
Keloids develop most often on the chest, back, shoulders, and earlobes. They rarely develop on the face (with the exception of the jawline).
Is keloid prevention possible?
The best way to deal with a keloid is not to get one. A person who has had a keloid should not undergo elective skin surgeries or procedures such as ear lobe or body piercing. When it comes to keloids, prevention is crucial, because keloids are not easy to treat.
|Keloids, by contrast, may start some time after the injury and extend beyond the wound site.|
What are the treatments for keloids?
The methods available to treat keloids are:
- Kenocort (triamcinolone) injections: These are safe and not very painful. Injections are usually given once every 4 weeks until the keloid is flat. The injection is mixed with a local anesthetic medicine called lidocaine to make it numb and less painful to inject. We charge RM100 per session for each small keloid (lesser than 3cm). It costs RM180 per session for large keloids (3cm or bigger). You may need 3 or 4 sessions to make it more flat. Some people may need even more injections, depending on their genetics, how well the respond to the injections and the size of the keloid. The injections may cause redness, swelling or sometimes scabbing for a few days. Kenocort injections will make the keloid flat, but it cannot remove the colour of the keloid. The colour can be removed using a Candela laser.
- Laser: Mediviron UOA Clinic uses Candela laser to make keloids look less red by reducing its vascularity. We use the spider vein removal handpiece on the Candela machine as the red or pinkish colour is due to the colour from tiny veins. The laser is safe, and has minimal redness, swelling or scabbing You may immediately return to work or your daily activities after the laser. We charge RM1000 per session of laser to do all the keloids. For best results, you need 6 sessions to improve the colour of the keloid. You can have a session once every 4 weeks. We can perform the laser for you when your keloid has become smaller and flatter after several sessions of Kenocort injection.
- Surgery: This is risky, because cutting a keloid can trigger the formation of a similar or even larger keloid.We do not perform keloid surgery in our clinic as this is not a good treatment option.
- Silicone sheets: This involves sticking on a sheet of silicone gel on the affected area for several hours a day for months or years, which is hard to sustain.. A well known brand is called Cicacare. Your keloid will improve about 10% after 6 months, so the results are not very good.
- Topical Ointments/ Oils/ Vitamin E cream/ Silicon Gel Sheet: There are many creams in the market which claim to improve keloid scar appearance. However, all of them do not work well and take a very long time for improvements. You would probably only see 10% improvements after 6 months of using the creams / oils/ ointments diligently, therefore it is not a very good treatment option.
In conclusion, the best treatment is having Kenocort injections to make the keloid flat and laser to make it less red or vascular. We can perform the laser for you when your keloid has become flatter after several sessions of Kenocort injection. You may need at least 2 -3 sessions of Kenocort injections and 6 sessions of laser.