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Keloids: What It Is And How You Can Treat It

Keloids scars that just keep on growing – are typically harmless. However, they can be unsightly and annoying. They affect as many as 1 in every 10 people and most often appear after an injury to the skin. Any injury beyond the body’s healing capacity is replaced with a collagen tissue which forms a scar. Scars represent the original injury site and are limited to the original size of the wound. Certain individuals have an inherent defect in their healing mechanism. Their body overreacts to the injury and the collagen deposition extends well beyond the original wound margins. Such a progressive scar is called a keloid and the person is said to have a keloidal tendency. If you develop a keloid you are likely to develop one every time you have an injury.

 

It not clearly understood why only a few people get keloids and others don’t. People with a keloidal tendency have a defective gene that regulates and controls the wound repair process. Some, but not all people have a familial tendency to develop keloids. The darker the skin color, the higher the chance of developing keloids.

 

What Causes Keloids? 

 

Keloids are caused due to an inherent defect in the body’s wound healing process. The body tends to over correct the original wound and the collagen growth extends way beyond the original injury. Getting a keloid is a genetic tendency and few people are more prone to keloids than others. Certain genes controlling the healing process are by default in them, so the body initiates the healing process by starting the production of collagen but it doesn’t know where to stop. It keeps on producing new collagen which is excessive and which gets arranged in abnormal fashion. Dark-skinned people are generally more susceptible to developing keloids and the severity is again more in dark-skinned individual. One of the reasons is that these individuals have a thicker, darker and curly hair which gets trapped in the keloid tissue and stimulates its growth. While the root cause of developing a keloid is not fully known, few factors are identified as trigger factors or aggravating factors.

  • Stretching of the wound
  • Delayed healing of the wound, badly cared for and infected wounds
  • Hairy areas
  • Oily skin with frequent break outs

How Can One Treat A Keloid?

Keloids are generally considered as difficult to treat. Recent research has shown that effective control of trigger factors and pressure therapy along with newer laser devices give excellent resolution of scars. Skin City has recently developed a protocol to treat keloids successfully, which incorporates a combination of Fractional lasers like Utrapulse, SCAAR FX, Fractional drug delivery and Enerjet JVR collagen remodeling along with traditional pressure therapy.

 

Are Injections Safe In The Treatment Of Keloids? 

Keloids are annoying abnormal growths on the skin that keep growing perpetually. There is a defect in the wound repair process. Any wound while healing stimulates collagen production to level the defect. However in a Keloid, the body keeps on producing new collagen in excess of what is required by the original wound. Hence the scar becomes raised well above the normal level of skin. Additionally the collagen production extends much beyond the original borders of the wound.

  • The first line for keloid treatment is pressure and creams.
  • The second effective treatment is injections.

Most doctors inject Triamcilone steroid or 5 Flouro Uracil into keloid tissue. Generally these injections give acceptable flattening of the keloid tissue in many patients, others get unacceptable complications. 5 Flouro Uracil injection is a common anti-cancer chemotherapy drug and is used to suppress activity of collagen producing fibroblasts. A higher concentration of injection or inappropriate depth of injection can cause skin necrosis. Excess quantity of injection can result in the drug getting into the blood circulation thus resulting in systemic side effects. Injecting Steroids into keloids is a common practice by many general practitioners. The right dilution of the injection and correct depth of injection into the belly of the keloid will decide its efficacy and safety. Common side effect of steroid injection is tissue atrophy, where the skin literally caves in this takes more than a year to recover. Another complication is developing telangectasia or a web of fine red capillaries, which is a sign that the skin has become very thin. Sometimes the injection slips into surrounding tissue making that skin pale or white or resulting in the development of stretch marks in the area. Injecting too much or too frequently can cause the steroid to get absorbed into the circulation thus resulting in the development of acne like lesions on otherwise normal parts of the body. New pus filled pimples always have a chance to convert into a new keloid. Injecting into a very thick keloid is always painful. Keloids have thick bundles of collagen.

Many a time the injected material is not distributed uniformly into the keloid tissue. Fractional drug delivery is the latest technology used to allow the drug to penetrate uniformly into the tissue. Enerjet JVR is another technology that achieved fractional drug delivery along with collagen remodeling. Though injecting into the keloid is an effective way of controlling the growth temporarily, most times the patients end up with complications. Choosing the right injection ingredient and the right technique usually remains in the hands of the treating physician. On the other hand the onus is on the patient to choose an experienced doctor with an expertise in treating keloids. Also remember that there are many treatments available beyond injections for keloids that have proven successful.

 

Can Keloids Be Cured? 

Keloids are a different version of scars. Scars are usually the attempt of the body to heal the area of injury by replacing damaged tissue with collagen. When this collagen production becomes excessive the scar becomes thick and is called hypertrophic scars. The hypertrophic scar still remains within the boundary of original injury. When this collagen production extends way beyond the margins of the original wound and collagen becomes excessive in normal tissue, it is called a keloid.  Keloids are an inherent defect in the body’s healing process. The exact cause is still unknown. The genes controlling collagen production during healing have a defect. Keloids are more common in darker individuals.

 

Though the basic gene defect is still unknown, much is known about trigger factors and aggravating factors that make the keloid worse.

  • Excess hair in and around the wound
  • Oily skin and pimple prone skin
  • Recurrent infections and abscesses
  • Tension on wound like wounds on the shoulder or knees

 

When someone has a keloidal tendency, not all the wounds in that patient become a keloid. It is observed that only uncared for wounds and delayed healing leads to keloids. So any injury in keloid prone patients needs a prompt treatment of infection and a timely wound care. So, prevention is better than cure, when it’s the case of keloids. The keloidal tendency is an inherent defect so it cannot be removed. But it can be successfully treated with combinations of the latest gadgets like Ultra Pulse, SCAAR FX and Enerjet JVR.

 

Can Keloids Be Treated With Surgery?

Keloids are known to arise from surgical scars. Just removing the keloid by surgery is not a solution for keloid. They tend to reappear in the same site and grow more aggressively. They have inherent growth factors which aid them in growing and extend beyond the margins of the original wound. Removing a keloid by surgery leads to recurrence in almost 100 % of cases.

 

Can Keloid Recur After Treatment? 

Almost all keloids recur despite treating them with multiple treatment modalities. Silicone gel sheets and pressure garments have been used to prevent them from recurring however they have certain limitations. Steroid Injections decrease the size of keloids, however they cannot be given in large areas and have side effects. They also cause infection in the keloids which in turn aggravate the keloid further. However with newer technologies like Ultrapulse SCAAR Fx, Dermatransport and Enerjet JVR, keloids can be treated successfully and with lesser chances of recurrence. Tailored protocols with a combination of the above modalities will reduce the size and improve the colour and texture of the keloids.

 

There is No scar cream that can remove a keloid, but lasers can.

Keloids are thick firm masses of scar tissue. They are in fact impenetrable to creams and lotions. The Internet is filled with so many misleading and irrelevant remedies which will aggravate the keloid rather than cause it to subside. No cream, home remedies, unscientific treatments can reduce the keloid. They have to be handled with care by highly qualified professionals who understand the exact mechanism and development of keloids. Lasers are razor sharp beams of light which have the ability to penetrate the keloids and transport the necessary ingredients into the keloid tissue uniformly. They are highly effective with minimum side effects.

 

How To Avoid A Keloid?

  • People with keloids are genetically predisposed to develop keloid. So the most important thing is to avoid injury. They have to avoid piercing and other invasive procedures which will lead to a keloid. In unavoidable circumstances where an injury occurs, proper wound care with dressing should be done. Once the wound heals, they have to be kept moist with moisturizers and protected from friction at the site. Pressure garments and silicone gel sheets have a role in preventing keloid formation.

 

  • Keloid prone areas like the chest and shoulders should be devoid of hairs as the hair follicles trigger inflammation and subsequent keloid formation. A major preventive measure is laser hair reduction. Lasers will destroy hair follicles and prevent the chances of irritation caused by them which may trigger a keloid.

 

  • Just after a major surgery like bypass surgery which is more prone to develop into a keloid, the wound can be treated by vascular lasers which target the vascularity of scar and hence will prevent the development of keloid.

 

Schedule Your Consultation At Skin City

Until now, there haven’t been effective treatments to treat Keloids, and many sufferers who are genetically prone to keloid – believe they simply must live with the scarring. Skin City is changing all that with a non-surgical treatment option that has a remarkable reduction rate on all skin types. Now there’s finally help that really works.

About The Author

Skin Specialist in Pune

Dr Niteen Dhepe is a Board Certified Dermatologist and has developed himself as a pioneer in field of Cosmetic Dermatology and Lasers in India. He is the biggest entrepreneur in contemporary dermatology world of India.

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