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Keloids: Diagnosis and treatment


How do dermatologists diagnose keloids?

A dermatologist can usually diagnose a keloid by looking at it.

If a keloid looks like a worrisome skin growth, a dermatologist may perform a skin biopsy. This involves removing a small section so that it can studied under a microscope. A dermatologist can quickly and easily remove a small section during an office visit.

How do dermatologists treat keloids?

To give their patients the best results, dermatologists may recommend more than one type of treatment for a keloid. These scars can be difficult to get rid of, and some return after treatment. Using two or more types of treatment often improves results.

Before your appointment with a dermatologist, it’s helpful to think about what you expect from treatment. Think how you would answer the following questions:

  • Is easing a symptom like pain or itch most important to you?

  • Will flattening or softening the keloid help you feel better?

  • If you have a keloid on your ear, is your primary goal to wear earrings again?

Knowing what you expect will help your dermatologist provide you with realistic information about what treatment can do. It will also help your dermatologist create your treatment plan.

If you’ve had keloid treatment before, make sure your dermatologist knows.

A treatment plan for keloids may include:

Injections of corticosteroids and other medicines: These injections are often part a treatment plan for keloids. When injected into the keloid, these medicines help to shrink the scar.

Patients usually receive a series of injections once every three to four weeks. On average, patients return about four times for these injections. The first injections tend to relieve symptoms and make the keloid feel softer.

Between 50% and 80% of keloids shrink after being injected. Many of these keloids, however, will regrow within five years. To improve results, dermatologists often add another therapy to the treatment plan.

Surgical removal (keloid surgery): This treatment involves surgically cutting out the keloid. While this may seem like a permanent solution, it’s important to know that nearly 100% of keloids return after this treatment.

To reduce the risk of a keloid returning after surgical removal, dermatologists often treat patients with another keloid treatment after the surgery. Injections of corticosteroids or cryotherapy may help reduce the risk. If the keloid is on an earlobe, wearing a special earring that puts pressure on the earlobe can prevent the keloid from returning.

Receiving radiation treatments after surgical removal may also prevent a keloid from returning.

Pressure earring, dressing, or garment: This is often used after keloid surgery. Putting pressure on the area reduces blood flow, which can stop a keloid from returning.

Between 90% and 100% of patients who use this treatment as directed after keloid surgery can prevent another keloid.

Using this as directed, however, can be difficult. These devices tend to be uncomfortable. To get results, a patient must wear it for up to 16 hours a day for 6 to 12 months.

The pressure earring tends to be easiest to wear. It is often recommended after a dermatologist removes a keloid from an earlobe.

Laser treatment: This can reduce the height and fade the color of a keloid. It’s often used along with another treatment like a series of corticosteroid injections or pressure.

Silicone sheets and gels: These may be used along with pressure to prevent a keloid from returning.

Sometimes, silicone is used alone to flatten a keloid. In one study, 34% of the raised scars had some flattening after patients used the silicone gel daily for six months.

Cryotherapy: This treatment freezes the keloid from the inside out while saving the skin beneath the keloid. It’s used to reduce the hardness and size of a keloid. Cryotherapy works best on small keloids.

Having a few cryotherapy treatments before (or after) receiving injections of corticosteroids may reduce the size of a keloid. This can make the injections more effective.

Dermatologists have found that patients who have three or more cryotherapy treatments tend to get the best results.

Radiation treatments: Getting radiation therapy after your dermatologist surgically removes the keloid may prevent the keloid from returning. Patients may begin radiation treatments immediately after keloid surgery, the next day, or a week later.

Radiation may also be used alone to reduce the size of a keloid. Results, however, tend to be better when it’s used after keloid surgery.

Ligature: If a surgical thread can be tied around the keloid, your dermatologist may recommend this treatment. The surgical thread will gradually cut into the keloid, which can cause it to fall off. You’ll need to tie a new surgical thread around the keloid every two to three weeks.

Other treatments: To improve results, dermatologists are studying new treatments. To give you the best results, your dermatologist may recommend another treatment option.

What is the outcome after treatment for a keloid?

Treatment can reduce the size of keloid. It can reduce symptoms like pain and itch. Sometimes, treatment gets rid of a keloid.

Even after successful treatment, some keloids return. Following your dermatologist’s instructions can help you reduce the chance of a keloid returning. It will also help you get the best results from treatment.


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References
Burton CS and Escaravage V. “Hypertrophic scars and keloids.” In: Bolognia JL, et al. i. (second edition). Mosby Elsevier, Spain, 2008:1499-1502.

Daggett A, Congcharoen J, et al. “Top 10 things you need to know about keloids and their treatment.” J Miss State Med Assoc. 2016;57(4):108-11.

Kelly AP. “Keloids” In Kelly AP, Taylor SC, et al. Dermatology for Skin of Color. The McGraw Hill Companies, China, 2009. 178-94.

London, S. “Management of keloids draws on clinical wisdom.” Dermatology News (Digital Network). 2013 Nov 1 2013. Last accessed September 30, 2016.

Son D and Harijan A. “Overview of surgical scar prevention and management.” J Korean Med Sci. 2014;29(6):751-7.

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