A keloid is a cutaneous mass that characteristically develops following a dermal injury. The keloid has beset dermatologists and cosmetic surgeons for decades, in view of both its pathological evolution and therapeutic challenges. Classically described as an overgrowth of tissue that extends beyond the borders of the original wound, keloids differ from that of hypertrophic scars.
Many patients ask for their keloid scar to be “cut out,” or surgically excised, though this is hardly ever successful and, in fact, can result in an even bigger keloid scar coming back. There are many treatments for keloids, but no single therapeutic modality is best for all keloids. The location, size, and depth of the lesion, as well as the age of the patient and the past response to treatment, will best determine the type of treatment used.
Treatment options can involve any of the following, and involve combinations of the therapies listed below:
Intralesional steroid injections, with triamcinolone, are a mainstay of treatment and prevention, though this usually requires multiple treatments. Patients will need to be seen for injections every 2-6 weeks until improvement is seen.
Pressure or occlusive dressings
These are used for both treatment and prevention, with minimal adverse effects, provided they are practical and acceptable to the patient.
Freezing keloids with liquid nitrogen may flatten them, but often darkens or lightens the site of treatment. While cryotherapy has been used alone, it is often seen in combination with other treatments, though reported results have varied.
The evidence base supporting the use of lasers in keloid scars is not as large as that supporting their use in hypertrophic scars. The pulsed-dye laser can be effective at flattening keloids and making them look less red, but further research is required.
Surgical excision on its own has a very high recurrence rate and the recurring scar may even be larger than the original. Results may be improved by additional treatments such as intralesional steroids, occlusive or pressure dressings, or radiotherapy.
Keloids have been treated by using radiation for over a century, and the combination of surgical excision and radiation therapy has long been considered one of the most effective treatment plans for the prevention of keloid recurrence. Yet with emerging technologies, such as the SRT-100, which delivers a precise, calibrated dose of Superficial Radiation Therapy without the involvement of cutting, bleeding, or stitching, the use of radiotherapy is quickly becoming the go-to single form of keloid treatment.
For more information on how your practice can begin to use emerging technologies like the SRT-100 in keloid treatment and prevention, contact Sensus Healthcare today.