Keloids scars are usually asymptomatic but sometimes itchy and painful. They first starts with pink or red, firm rubbery that usually remains for several months and later untrolled growth occurs and becomes hyperpigmented and harder. The formation of keloid scar might also associated with other dermatological conditions so careful examination is required.
Keloid scar are difficult to treat. Many options are under use with or with out much success and chances of reccurence are frequent. Some of the options are discusses below.
Intralesional corticosteroids injection: This is often used as first line of treatment for keloid scar removal and has excellent results. Depending on the anatomic location high concentration of medication ( triamcinolone acetnide or diacetate ) is injected. Multiple injection over several months might be needed. Injection with combination with 5-flurouracil has been tried and has given more success results. It is injected once or twice weekly and later is decreased to monthly interval.
Silicone gels and occlusive sheeting: For small lesion once or twice daily application of Silicone or occlusive sheeting has given some success rates. This treatment has fewer side effects and patients can self apply themselves.
Cryosurgery: For some small lesions cryosurgery might be a good options too. Cryosurgery cause local ischemia and necrosis thus resulting in flattening of the scar. There might be few complications but not always which might be: hypopigmentation, edema, hypoesthesia and pain.
Surgical excision: For large keloids scar removal, surgical excision is the only effective options. It doesn’t completely remove the scar but makes it narrow and probably cosmetically acceptable. But excision might lead to reccurence of scar so topical therapy or even intralesional corticosteriods injection for several months with or without some skin lightening products might be needed after surgery for better result.
Laser Surgery: Laser surgery using CO2 or Nd:Yag have been tried but not much successful. Pulsed dye laser (585 nm) have shown some good results in keliod scars.
Intralesional bleomycin: Some study has suggested that using intralesional bleomycin has signuficient flattening of the scar.