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Keloid scars: Diagnosis and treatment


Many people who have keloids want to know about treatment. A keloid can feel uncomfortable, itchy, or painful. If a keloid develops over a shoulder or other joint, it can limit how far you can move. Many people simply dislike the way keloids look.

Here’s what you can expect when you see a board-certified dermatologist for treatment.

How do dermatologists diagnose keloids?

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

Sometimes, another skin condition can look like a keloid. For example, if someone has an allergic skin reaction to the gold in their earrings, the swelling can look like a keloid.

If it looks like you might have another condition, your dermatologist can perform a skin biopsy. This is a simple procedure that your dermatologist can perform during your office visit. You remain awake the entire time.

To perform a skin biopsy, your dermatologist numbs the area and removes a small amount of skin so that it can be examined under a microscope.

Your dermatologist sends the removed skin to a medical lab. The doctor who examines what your dermatologist removed will write a report. It tells your dermatologist what was seen under the microscope.

If you have a keloid, your dermatologist can create a treatment plan tailored to your needs.

How do dermatologists treat keloids?

To give their patients the best results, dermatologists often 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. For example, how would you 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

It’s important for your dermatologist to know how your skin responded to the previous treatment.

Dermatologist discussing treatment plan with patient

A treatment plan for keloids may include:

Injections of corticosteroids or another medication: 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. 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, your dermatologists may follow these injections with one or more treatments like keloid surgery or prescribe a pressure garment.

Corticosteroid injections can be especially helpful for a keloid on an ear. When you have a keloid on an earlobe, it may also be helpful to wear a special earring that puts pressure on the earlobe. Called a pressure earring, it can help to prevent the keloid from returning.

If you have a darker skin tone, a possible side effect of corticosteroids injections is light spots developing where you get these injections. To prevent this, there are other medications that your dermatologist can use.

Keloid surgery: Your dermatologist can surgically cut 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, most patients have another treatment after surgery. Wearing a pressure garment or getting cryosurgery (see below) can help reduce the risk of a keloid returning.

To help reduce the risk of a keloid returning after surgery, some patients receive a series of corticosteroid injections before surgery. For example, a dermatologist may give you injections of corticosteroids every 2 to 3 weeks for four sessions before surgery.

Pressure earring, dressing, or garment: Often used after keloid surgery to reduce blood flow. This may stop a keloid from returning.

Using a pressure earring or garment as directed, however, can be difficult. These devices tend to be uncomfortable. To get results, a patient must wear the device for 12 to 20 hours a day for several months.

A pressure earring tends to be easiest to wear.

Silicone gel sheets: Made from medical-grade silicone, these sheets may help to flatten a keloid. For this reason, silicone gel sheets may be applied to a new keloid or applied after an injury to prevent a keloid from developing.

When using silicone gel sheets, never apply one to a scab or open wound

Once these heal, you can start using the silicone gel sheet.

Hands peeling silicone gel from its backing

Dermatologists also include silicone gel sheets in a treatment plan. They can help prevent a keloid from returning after another treatment like keloid surgery.

Freezing (cryosurgery): If you have darkly pigmented skin, this may not be recommended. Cryosurgery can cause a permanent light spot on brown or black skin. If your dermatologist recommends cryosurgery, a very cold substance will be used to freeze the keloid from the inside out while saving the skin beneath the keloid. This can reduce the hardness and size of a keloid. Cryosurgery works best on small keloids.

Because using a combination of treatments often works best for treating keloids, cryotherapy may be used after keloid surgery. Cryosurgery is usually performed about two weeks after you have your stitches removed. It can help reduce new scar tissue from forming.

Cryosurgery is also recommended before (or after) receiving injections of corticosteroids. Cryosurgery may reduce the size of a keloid, which can make the injections more effective.

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

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

Radiation treatments: For more than 100 years, radiation has been used to help prevent a keloid from growing back after you’ve had another treatment like surgery.7,10,11 Sometimes, radiation is the only treatment used; however, this is less common today.

While radiation treatments can help, this treatment has drawbacks. It can be hard on your skin, causing peeling, itching, and permanent skin color changes. There also have been reports of patients developing cancer many years after having radiation treatment for keloids.2,3

Dermatologists take these reports seriously. Because the reports lacked essential details like how much radiation each patient received and the safety measures that were taken to protect the patient, dermatologists reached out to oncologists (cancer doctors) for more information.

What they found suggests that a type of treatment called superficial radiation therapy (SRT) can be used after keloid surgery (or another treatment) to reduce the risk of a keloid returning. SRT is appropriate when safety measures are taken to reduce the cancer risk. These measures include using the right dose of radiation and protecting areas of the body that don’t need radiation treatment.9

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.

New and innovative options for treating keloids

No treatment can consistently get rid of a keloid. What works for one patient may have no effect on another patient. There is not a treatment that will always prevent a keloid from returning after it’s treated.

For these reasons, dermatologists are working to better understand what causes keloids and develop more effective treatment. Never before have there been so many treatment options in development.

If one of these newer treatments could help you, your dermatologist may talk with you about it, especially if other treatments have not helped.

What can improve results after keloid treatment?

How you care for your skin can make a difference. Be sure to follow the at-home care that your dermatologist gives you. You also want to stick to your treatment plan, getting all treatments that your dermatologist recommends.

It’s also important to know that if you’ve had a keloid, you can develop another keloid scar in the future. Find out what you can do to reduce your risk at Keloid scars: How to prevent.


Image
Getty Images

References

  1. 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.

  2. Dzul S, Jaenisch H, et al. “Radiation induced mucoepidermoid carcinoma of the parotid gland following post-operative radiotherapy to the earlobe for keloid prophylaxis.” Ear Nose Throat J. 2022:1455613221099998.

  3. Fortson JK, Rosenthal M, et al. “Atypical presentation of mucoepidermoid carcinoma after radiation therapy for the treatment of keloids.” Ear Nose Throat J. 2012;91(7):286-8.

  4. Jacobs C, Wilmink J. “Combined versus single treatment regimens for keloid therapy using serial intralesional corticosteroid injections, surgical excision, silicone- and/or cryotherapy.” JPRAS Open. 2021 Jun 3;29:157-166.

  5. Kelly AP, Bayat A. “Keloids” In: Kelly AP, Taylor SC, et alDermatology for Skin of Color. The McGraw Hill Companies, United States of America, 2016.208-222.

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

  7. Mankowski P, Kanevsky J, et al. “Optimizing radiotherapy for keloids: A meta-analysis systematic review comparing recurrence rates between different radiation modalities.” Ann Plast Surg. 2017;78(4):403-11.

  8. O'Brien L, Pandit A. “Silicone gel sheeting for preventing and treating hypertrophic and keloid scars.” Cochrane Database Syst Rev. 2006 Jan 25;(1):CD003826. 

  9. Ogawa R, Yoshitatsu S, et al. “Is radiation therapy for keloids acceptable? The risk of radiation-induced carcinogenesis.” Plast Reconstr Surg. 2009;124(4):1196-1201.

  10. Shin JY, Lee JW, et al. “A comparison of the effectiveness of triamcinolone and radiation therapy for ear keloids after surgical excision: A systematic review and meta-analysis. Plast Reconstr Surg. 2016;137(6):1718-25.

  11. Siotos C, Uzosike AC, et al. “Keloid excision and adjuvant treatments: A network meta-analysis. Ann Plast Surg. 2019;83(2):154-62.

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

  13. Vannala V, Mahabob N, et al. “A case of keloid.” J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S871-S874.


Written by:
Paula Ludmann, MS

Reviewed by:
Arturo R. Dominguez, MD, FAAD
Ivy Lee, MD, FAAD

Reviewed by: (Information about radiation treatments only)
Neelam Khan, MD, FAAD
William W. Kwan, MD, FAAD
Shari Lipner, MD, PhD, FAAD
Bassel Hamdy Mahmoud, MD, PhD, FAAD
Omolara Olowoyeye, MD, FAAD
Mario J. Sequeira, MD, FAAD

Last updated: 11/18/22

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