Keloids form as a result of skin injury where the scar becomes larger than the wound. Scars are the body’s natural response to skin injury and often heal without forming lesions. However, when the scarring process results in a growth, it forms a keloid or a hypertrophic scar.
This type of scar formation barely poses any medical problem, but most people opt to remove them for cosmetic reasons. Instead of forming a scar that levels with the surface of the skin, the scar tissues continue to grow due to an overproduction of collagen in the wound.
The Development Process of Keloid Scars
Although keloid scars can develop on any part of the body, they are more common on the shoulders, upper back and chest, abdomen, and ears. Sometimes, they occur after an injury or cosmetic procedures.
In some cases, keloids develop months later. They form into soft, raised, firm growths that overtake the wound and continue to grow beyond the wound boundaries. In fact, it is this feature that differentiates keloids from hypertrophic scars. Hypertrophic scars also appear raised but they don’t grow beyond the boundary of the wound.
Risk Factors for Developing Keloids
Several factors lead to keloid formation – burns, surgical excisions, skin injuries, acne scars, body piercings, and sometimes, trauma. Hormonal dysfunctions and infections are also presumed to cause keloids.
While anyone can develop this type of scar, people aged 10-30 years are more likely to develop them. There are also instances when an improper administration of immunization cause keloids. Moreover, people who have darker skin tones form keloids more often than those with lighter skin. Women who have had ear piercings, c-sections and other forms of surgeries may also develop keloids.
Symptoms of Keloid Scars
Keloids are raised, dome-shaped, shiny, and vary in color (from red to pink). Some scars can get incredibly large and unsightly. Apart from causing cosmetic problems, keloids tend to be itchy, painful, and tender.
Available Removal Treatments
Treatment methods depend on the location, depth, and size of the scar. A patient’s age also plays a critical role in the removal of keloids, and past responses to treatment determine the kind of therapy the doctor uses. The most common therapeutic treatments for keloids are the following:
The procedure is considered rather risky as cutting the keloid may trigger the formation of larger scars. Some surgical procedures are successful when combined with injection steroids. Other medical methods involve compression using special pressure devices on the wound for several months after cutting the keloid. A post-surgery superficial radiation has also been proven effective after a surgical excision.
2. Compression Therapy
It is a standard treatment that involves the use of pressure-gradient garments to constrict the wounded region. The treatment became popular after doctors discovered that patients suffering from burns healed faster using pressure stockings.
Compression therapy is a first-line treatment that is primarily designed for improving scars of burn victims and treating hypertrophic scars and keloids. It treats keloids by reducing blood circulation to the scar, which helps rid of the cells that aid in the creation of collagen, thus shrinking keloid scar tissue.
An examination of keloids that are treated through compression therapy has shown it led to less cohesiveness between collagen fibers, causing a breakdown of the nodules in the tissue. The pressure garment enhances enzyme activity in the tissue. It breaks down the collagen while reducing the number of particular proteins, as well as the large carbohydrates that inhibit the breakdown.
Note that the use of compression therapy to treat keloids is only effective when it is administered along with steroid injections or when combined with surgical procedures. According to clinical studies, it is only effective as a stand-alone therapy when used to treat the reoccurrence of keloids that develop on the ear.
Additionally, it is more effective on keloids that are less than a year old and makes a preventive measure for wounds that take two to three weeks to heal.
This treatment method remains the most effective in the management of keloids and excessive production of tissues in the scars. As earlier highlighted, keloids form as a result of the growth of collagen tissues, growth factor actions, and mechanical forces applied to the skin.
Corticosteroids operate by increasing the basic fibroblast growth factor while reducing the transformation of the growth factor-ẞ1. Presently, the most effective corticosteroid therapy involves the injection of intradermal steroids after surgical excisions to reduce the risk of reappearance of the scar.
4. Silicone Sheeting
This makes a noninvasive method of treating keloids. In fact, since the 1980s, silicone gel sheeting has been known to be the most effective treatment method for keloids and hypertrophic scars with various clinical studies confirming its efficacy.
When the method was first discovered, doctors used topical silicone gel sheeting to reduce the scars. With time, the method was found to be cumbersome, and the patient compliance was pretty low for scars that developed on visible areas.
Meanwhile, a silicone sheeting with the use of bandages and tapes may lead to skin irritation, causing discontinuation of the treatment during hot climates. The topical silicone gel application is only appealing when it overcomes limitations of steroid injections such as dyschromia and skin atrophy.
With time, self-drying silicone gel was developed. The method is preferable as it does not require fixation; it is invisible when dry and allows the application of makeup and sunscreens.
It is also known as cryosurgery and is performed in the doctor’s office. The treatment is usually administered by spraying on the keloid, but newer methods like intralesional processes involve applying the nitrogen liquid inside large keloids.
It works by damaging collagen tissues, causing the scar to flatten. Note that cryotherapy is a first-line treatment method whether it is administered exclusively or along with other kinds of therapies. When it is used along with steroid injections, the doctor makes a light application to soften the scar.
Cryotherapy has a high response rate when used on recently developed keloids, but it is more effective when steroid injections are also administered. Since the spraying method is often associated with hypopigmentation (losing the skin color), intralesional cryosurgery makes a more viable solution.
Most patients experience hypopigmentation after the administration of spray or contact cryotherapy, hence any reduction in this adverse side effect makes the treatment method viable.
Interferons are proteins produced by the immune system to fight off bacteria, viruses, and other kinds of allergies. Based on medical studies, the injection of interferons helps reduce the size of keloids, though they are yet to prove whether the method is long-lasting.
6. The Use of Retinoid
This treatment is ideal for patients looking for over-the-counter remedies for treating keloids. Being a natural derivative of vitamin A, the retinoid is used to improve the appearance of aging skin. Studies show that retinoids aid in the regulation of collagen production and other skin cell factors – a process that counteracts the dysfunctional activity in keloid skin cells.
A few studies also confirm that 0.05% topical retinoic acid effectively treats keloid scars in some people. Two clinical trials involving the application of topical retinoid cream on keloids resulted in significant reduction of the scars in most patients. It was also reported that the patients experienced a notable improvement in keloid symptoms like itchiness.
Laser treatments are classified into two – ablative and non-ablative treatments. Ablative treatments like carbon dioxide lasers involve the use of surgical scalpels to cut out the keloid and are usually less traumatic than actual surgery.
Non-ablative lasers, on the other hand, use non-invasive heating methods to remove the scars. The PDL (pulsed-dye laser therapy) is an example of non-ablative laser treatment.
Doctors factor in several elements when determining the ideal treatment for their patients, including any prior treatment, level of skin pigmentation, inflammation, prior treatments, and current medications. Prior therapies or medications may cause the doctor to delay a laser therapy procedure.
For instance, patients taking blood thinners may be required to discontinue for a week before the treatment.
Additionally, patients who have had cosmetic filler injections or hypopigmentation from previous treatments may not be the best candidates for laser treatments. The patient’s skin color also affects that dosage administered.
Ablative or carbon dioxide laser treatment involves the use of excessive heat to shrink collagen tissues. It is also used to cut the keloid and seal the wound. The non-ablative laser treatment involves creating heat within the vascular cells with the aim of cutting off blood supply.
Some studies also show that non-ablative laser treatment like PDL inhibits inflammatory factors while enhancing the activity of enzymes that break down collagen tissue. Pulsed dye lasers have been reported to be only effective in eliminating redness and itchiness of keloids. However, their usefulness in removing keloids is limited unless they are combined with steroid injection.
Cost Freak suggests that the cost to remove a keloid scar is $700 to $800 for every session, but it depends on the severity of the scar and the procedure used. The treatment for burn scars, keloid scars, and hypertrophic scars are different from acne scar treatment.
Other factors like the kind of practitioner performing the procedure also affect the cost. Scar removal specialists and medical professional dermatologists may charge a higher price than ordinary doctors.
The discussion gives a detailed overview of how keloids form, their symptoms, and the various treatment options available. With these various keloid scar removal methods, you regain a smooth skin and will no longer need to feel embarrassed.
Written by – Rebecca Johnson graduated with a Mass Communications degree. She loves to write and has written a number of articles about health and beauty. Currently, she manages and writes the content of costfreak.com a website that provides up to date costs of products and services.