How to Treat a Keloid Scar

At DermTV, I get a lot of questions about keloid scars and the best news I can give you if you think you have keloid scars is that most people who think they have them really don’t, they really have hypertrophic scars, which are much easier to treat. Let me explain. If you have an injury or even a surgical procedure that creates a cut that’s repaired in the shape of that line and you get a hypertrophic scar, the hypertrophic scar is the approximately the size or the footprint of the original injury, it’s raised but it’s generally the area of the injury. If you get a keloid in response to that injury it’s not only raised but it has no relationship to that line so it starts to grow but almost looks like a cauliflower type of shape, it almost acts like an independent autonomous tumor that grows. In another episode I discussed the treatment of raised hypertrophic scars; unfortunately those treatments usually do not work for the treatment of keloid scars. So just rubbing the keloid scar with firm pressure doesn’t make it better, using over the counter silicone gels and sheets doesn’t help; even my lasers don’t help keloid scars. The best way to treat keloid scars is with injections of concentrated cortisone right into the scar. They’re repeated at 2 to 3 week intervals, they cause the scar to become softer when they get softer they absorb more of the cortisone and the cortisone melts the extra collagen, the fibrous tissue in the scar and reduces its size. If that doesn’t work then the only other option is having the keloid scar surgically excised but when you surgically excise it you create another injury and people prone to forming keloids, form them in response to all injuries. So, we’re always concerned that removing the keloid surgically will result in an additional keloid. To help prevent that, during the surgical procedure, we inject concentrated cortisone into the surgical site so the cortisone is there to help prevent a keloid from recurring. And after the skin heals, it’s monitored carefully by both the patient and the physician so at the earliest signs of raising up of the skin, as if the keloid were trying to reform, it’s again injected with cortisone to drive it back down and to control it and often that will result in a superior cosmetic result. But keep one thing in mind, if you think you have a keloid scar, at home treatments are not going to help you, it’s time to see a dermatologist.