Scars and keloids on the skin can be unsightly and cause discomfort in a number of ways. Problematic scars can occur anywhere on the body as a result of trauma to the skin. There are many treatments available to help reduce their appearance. These options include topical treatments, injections into the scar, laser therapy, and scar revision surgery.
A keloid is an excessive production of scar tissue that can result from a cut, burn, surgery, scratch or even acne and body piercing. A keloid scar grows larger than the original wound itself. These can develop even when there is no obvious damage to the skin at all. Keloids occur when collagen (a structural protein in the skin) overgrows and produces a lump much bigger than the wound itself. Keloids differ from hypertrophic scars by the fact that they spread beyond the area of the wound. Keloids are often shiny, reddish in colour, hairless, feel firm and rubbery to the touch and are mostly painless. However, sometimes keloids can be itchy or painful. It can take up to a month for a keloid scar to appear and these can continue growing for months and even years. Keloid scars affect about 10-15% of all wounds.
It is not fully understood why these types of scars occur but keloids form due to an over production of collagen. 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 can affect anyone but 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 (usually due to pierced ears). Other commonly affected areas include the lower legs, chin and neck. 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 men and women who feel the need to shave on a daily basis. Keloids can develop or even become larger during pregnancy. The tendency to scar in this way can 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. It might not be possible to avoid keloid scars developing, but you can reduce your chances of getting them by avoiding deliberate breaking of the skin such as with tattoos and piercings. Early treatment is the best way to prevent this type of scar from growing bigger and becoming more unsightly. If you suffer from acne, treating the acne itself will reduce the chances of acne scarring and the development of keloids.
Other 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 scar reduction.
A range of topical treatments are marketed for the treatment of keloid scars but only a few are effective. Always discuss your treatment options with your dermatologist first before starting a new treatment. A dermatologist can prescribe a strong steroid cream or steroid-containing tape that can be effective in reducing the appearance of early scars. Silicone dressings or gels are a safe option and work to soften and flatten the keloid scar. These can be purchased from a pharmacist without a prescription.
A consultant dermatologist can apply liquid nitrogen to the scar for a few seconds and freeze the keloid. When keloids are small, cryotherapy can diminish their growth. You may need repeated sessions of cryotherapy for it to be effective. This treatment option is most effective when 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 the 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. Other types of injection therapy include 5-fluorouracil and bleomycin.
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 steroid injections or silicone gel sheeting.
As all keloid scars are different and come in many shapes, variations and sizes, your treatment plan will depend on the type of scar you have, as well as its location on the body.
During your first consultation, your Dermatologist will examine your keloid scar and first confirm that this is the correct diagnosis. They will ask you what caused the scar, when the scar occurred, as well as any treatments you have tried in the past.
Depending on the severity of the scar and the steps you have already taken/ the time passed since it occurred, your Dermatologist may suggest topical creams or cryotherapy as a first step. It may be a case of trying out a few different things, to see what works best for reducing your scar.
Your Dermatologist will be very honest with you about your expectations in terms of eliminating your scar, as this may not be possible, but we aim to give you the best result we can.
Scar Revision Surgery is normally a last resort or used in cases where the keloid scar is large and has been there for many years. The decision of whether to do this will depend on the location of the scar on the body and the effect the scar is having on your life. We can offer you our best advice and professional opinion, but you may wish to choose the option which is best for you.
Your Dermatologist will discuss all the options with you, as well as any side effects, risks or after care associated with each treatment plan. Rest assured that you are in safe, professional hands at The London Dermatology Clinic.
Dermatologists at The London Dermatology CentreTM will be able to assess your scar or keloids and advise you on the best management plan and 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.
For more information regarding the treatment of keloid scars please contact us on 020 7467 3720.
Content by Dr Sunil Chopra and Rebecca Perris