Keloid Scar Treatment

Keloid scars represent a disordered and pathological type of scarring that most commonly develops as a result of traumatic injury or surgical incisions. Compared with normal scars, keloid scars are raised beyond the skin surface and are swollen-looking. They vary in in severity from a mild aesthetic concern to significant deformity with functional implications. Functional symptoms which keloids can cause include both itchiness and discomfort. Compared with the more common hypertrophic scars, keloid scars do extend beyond the original margins of the wound, which often gives rise to their unsightly appearance.

Keloid scars are more common in certain situations:

• Patients with darker skin
• The ears, upper chest, upper arms or shoulders
• Surgical wounds in areas of skin tension
• Following cosmetic surgery such as breast augmentation or tummy tuck
• The skin over mobile joints such as the elbows and knees

Keloid scars represent the over-proliferation of normal scar tissue beyond what is considered part of a normal wound-healing response. The fibroblast cells are the cells which manufacture collagen, and in keloid scarring, they have become overactive, leading to an overproduction of collagen. Keloid scars exhibit inflammatory changes and an abundance of new blood vessels, giving rise to their reddish appearance. These changes also result in localised pain and irritation.

Burn injuries are a prevalent cause of keloid scars, especially on the chest and shoulder region. Untreated or poorly treated acne most commonly results in atrophic acne scars but can also give rise to keloid scars, especially in darker skin types. Patients with inflammation of hair follicles (common in beard hair), people with body piercings and those sustaining small cuts may develop keloid scars. Surgical incisions risk keloid scars, especially in darker skin types.

Our dermatologists utilise a range of advanced treatments, including laser, in the management of these difficult-to-treat scars.

Steroid Injection

Injection of steroids into scars is a very commonly used treatment for keloid scar removal. The steroid impairs the production of excessive scar tissue. This leads to scar shrinkage after the steroid injection. A limitation of steroid injections is that large and thick scars are difficult to treat because scars are composed of tough and firm tissue. The steroid is, therefore, unable to spread evenly throughout the thickened scar. Any improvement in scar appearance is often uneven. Thick and dense scars need more than steroid injection alone.

Laser and steroid combined treatment for keloid scar removal

Nd:YAG laser is a synergistic treatment when combined with steroid injection. The laser acts deeply to interfere with blood vessel formation. By disrupting the blood vessels, the scar is unable to proliferate further and decreases in size. Laser treatment alone works well for scars that are flatter and thinner. However, in thick and dense scars, the laser should be combined with steroid injection for optimum results. Both treatments act to reduce the blood supply to the scar. Nd:YAG laser also causes the scar to swell, facilitating a diffuse and even injection of steroids throughout the scar tissue. The combination of Nd:YAG laser and steroid injection is the optimal treatment for thick and dense scars and leads to faster healing than either treatment alone. The scar can be treated in less treatment sessions and the cosmetic result is superior with combination treatment.

Fractional Erbium laser

The erbium laser in fractional mode works by the creation of multiple channels in the scarred keloid tissue. The formation of these microscopic treatment zones triggers scar remodelling through the production of new collagen. The scarred tissue undergoes a process of maturation, and the newly formed tissue closely matches that of normal skin. Fractional laser treatment is a well-accepted treatment for both burn scars and acne scars. The expert use of fractional laser by our dermatologists leads to better matching of both traumatic and surgical scars with the texture and appearance of surrounding skin. The use of fractional erbium laser is also often combined with steroid treatment for keloid scar removal. The micro-channels enhance the spread of injected steroids for optimum treatment of thick and dense scars.

Fully ablative erbium laser for scar reduction

A fully ablative erbium laser using the Fotona SP Dynamis is not a definitive treatment for both hypertrophic and keloid scars. Using an ablative laser alone for these scars will probably lead to the scar recurring. For thick and dense hypertrophic scars, the erbium laser in fully ablative mode can be used to reduce the scar’s size through precise tissue vaporisation. The resulting smaller scar, once healed, is then ideally treated with other methods such as fractional laser in combination with steroid injection. The use of a fully ablative erbium laser is ideal for speeding up the treatment process and with fewer treatment sessions required for adequate scar treatment.