Scars and keloids on the skin can cause discomfort in a number of ways and treatment to reduce their appearance is often sought. Problematic scars can occur anywhere on the body as a result of trauma to the skin. A number of treatment options are available, including topical treatment, injections into the scar, laser therapy, and scar revision surgery.
A keloid is an excessive production of scar tissue that can result from surgery, major surgery or even acne and body piercing. They can even appear when there is no obvious damage to the skin at all. They occur when collagen overgrows and produces a lump much bigger than the wound itself. Keloids differ from normal hypertrophic scars by the fact that they spread beyond the area of the wound. Keloids are shiny, reddish in colour, feel firm and rubbery to the touch and can be itchy or painful.
These exaggerated scars are most likely to occur between the ages of 10 and 30, usually when wounds are under pressure or get infected. They are more common in darker skin types and certain areas of the body.
The most commonly affected parts of the body are the upper chest, shoulders and earlobes. In people with darker skin, they also often appear in the beard area – a condition known as pseudofolliculitis barbae, which is worsened by shaving and irritating the skin above ingrowing hairs. This can be particularly distressing for women who feel the need to shave on a daily basis.
The tendency to scar in this way tends to run in families. Keloids often occur following chickenpox, scratches, acne, vaccination injections, burns, surgical incisions and traumatic wounds.
With scars and keloids, prevention is definitely better than cure. Measures for lessening the incidence of problematic scars include exfoliating and moisturising skin where ingrowing hairs are common, laser hair removal, and taking care of skin following an injury. When scars or keloids occur, a skin specialist can advise you of the best treatment for your problem. Our clinic offers several options for keloid reduction.
When keloids are small, cryotherapy can be used to freeze them and diminish their growth. This is most effective when treatment is started early.
A course of steroid injections is the most common keloid scar treatment therapy in the UK. Steroids prevent cells called fibroblasts from producing collagen, whilst they also weaken the scar and encourage it to flatten. Steroid injections can also reduce any itchiness and tenderness present. Despite the positive outcome of the effects of steroids on keloids, it can be difficult to inject them since these scars are very firm in texture. Also, when injected, progress can be slow, with scars often recurring within five years. Fortunately, absorption in keloids is poor, so only a very small amount of steroid enters systemic circulation. If you and your dermatologist agree on a course of steroid injections, you will visit the clinic a number of times, usually waiting between four to eight weeks between injections.
Lasers have been very successful in keloid scar treatment. The keloid tissue is precisely targeted with the laser, which diminishes its appearance greatly. It can cause the scar to flatten and match the colour of the surrounding skin. Some colour lasers, such as the KTP laser and pulse dye laser can be used to soften keloids so that they can be more easily injected with steroids.
Traumatic scars can often be improved with scar revision surgery, which involves cutting away the scarred tissue. A surgical scar will usually heal better and produce a neater mark, although these could stretch or widen in time. Surgery can be a useful option for releasing a tight scar that is close to a joint, repositioning a scar, or changing its shape. Surgical excision of hypertrophic or keloid scars is often used in association with other processes such as pressotherapy or silicone gel sheeting.
Dermatologists at the London Dermatology Centre are able to assess your scar or keloids and advise on the best management from the most effective treatment options available. Our team comprises some of the UK's leading dermatologists who will use the most minimally invasive treatments for scars where possible. Please contact our clinic in London on +44 (020)7 467 3720 to make an appointment.
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