Keloid scar treatment & removal in London
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 can be caused by keloids include both itchiness and discomfort. Compared with the more common hypertrophic scars, keloid scar 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
- Skin over mobile joints such as the elbows and knees
Keloid scars represent the over proliferation of normal scar tissue beyond on what is considered as part of 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 which gives rise to their reddish appearance. These changes also result in localised pain and irritation.
Burn injuries are a very common 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 carry a risk of 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.
Keloid scar treatment techniques
Injection of steroids into scars is a very commonly used scar revision treatment. The steroid impairs the production of excessive scar tissue. This leads to scar shrinkage after the steroid injection. A limitation of steroid injections are that large and thick scars are difficult to treat because scars are composed of a tough and firm tissue. The steroid is therefore unable to evenly spread throughout the thickened scar. Any improvement in scar appearance often is uneven. Thick and dense scars need more than steroid injection alone.
Laser and steroid combined treatment
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, 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 and this facilitates a diffuse and even injection of steroid throughout the scar tissue. The combination of Nd:YAG laser and steroid injection is 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 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. The micro-channels enhance the spread of injected steroids for optimum treatment of thick and dense scars.
Fully ablative erbium laser for scar reduction
Fully ablative erbium laser using the Fotona SP Dynamis is not a definitive treatment for both hypertrophic and keloid scars. Using 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 size of the scar through precise vaporisation of tissue. 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 fully ablative erbium laser is ideal for speeding up of the treatment process and with less treatment sessions required for adequate scar treatment.
Keloid removal before and after
What is the cause of keloid scars?The exact cause of keloid scars is still unknown. Keloid scars can occur after surgical procedures, traumatic injury to the skin and even after very minor injury to the skin. Examples of minor skin trauma include sites of immunisation, chickenpox and minor scratches to the skin. Keloids can even develop without a history of prior trauma to the skin. Keloid scars most commonly develop in younger people with darker skin types. There is a genetic component to keloid scarring and it can occur in families.
Which skin types are most prone to developing keloid scars?Darker Fitzpatrick skin types are most likely to develop keloid scars. In patients with lighter skin, the risk is often as low as 2-3% rising to as high as 10-15% in those with darker skin types.
Do keloid scars tend to develop in certain areas?Yes they do. Keloid scars do not have hair follicles on them and have a shiny appearance with a rubbery consistency to the touch. They tend to occur most commonly on the upper chest or decolletage and shoulder regions. The thinner skin over the sternum seems to be a particularly common area for their development. The earlobes also are a common site and can develop after ear piercing. In darker skin types, keloid scars can also occur on the scalp and in the beard area in men.
Are keloid scars dangerous?No. Although they may produce symptoms such as itchiness or pain on touching them.
Keloid scars can leave a significant psychological impact on sufferers despite their often small size and this tends to amplified in younger people leading to a loss of self esteem and confidence which could affect the ability to form relationships.
Keloids do not have the potential to become cancerous.
What does keloid scar treatment involve?Smaller keloid scars can be injected with injectable steroid called Triamacinolone and are an effective treatment depending on where the keloid is located and its size. Approximately 4-6 steroid treatments will be needed to reduce the size of the keloid scar. For larger scars, surgical excision may be more appropriate followed by a course of steroid injections. It is important to bear in mind that surgical excision alone may result in recurrence of the keloid scar, sometimes to a bigger size than before hence the need for combination treatment.
How long does keloid treatment take to perform?Steroid injection for keloid scars takes about 30 minutes to perform and a number of sessions may be required. Surgical removal of keloid scars usually takes about one hour under a local anaesthetic.