Keloid and Hypertrophic scars are fibro-proliferative disorders of the skin that are caused by abnormal healing of the injured or irritated skin such as trauma, burn, surgery, vaccination, skin piercing, acne, and herpes zoster.
Keloid scars are raised; round or oval with regular margins and some with irregular margins have a crab claw-like look. Keloids are firm with a smooth surface and extend beyond the edges of an original wound or trauma.
Keloids can occur anywhere on the body but occur more commonly over the face (low part), neck, ears, chest, shoulders, and upper arm. They are often associated with itching, pain, anxiety or depression, and disruption of daily activities. Colour and texture of the keloid scar is brown to dark brown and pink to cherry red, Keloids are firm, rubbery lesions or shiny, fibrous nodules.
Hypertrophic scars are similar, slightly smaller than keloid, develop directly at a wound site, and do not go beyond the bounds of injury. They are often raised, red, and regress over time.
Hypertrophic scars are flexible in nature and deposited with excess amount of collagen and fibrous connective tissues and they often contain nerves and blood vessels.
Keloids & Hypertrophic scars both are raised to have a heaped-up appearance. These scars rise above the rest of the skin, keloid remains elevated above 4mm to the skin surface.
The treatments for Keloid and hypertrophic scars are similar, but hypertrophic scars have a better prognosis with age. Hypertrophic scars can easily be treated however keloids are resistant to treatment. Treatment is based upon the depth, size, and location of keloid. History of previous treatment and its response is important before starting the treatment.
There are different treatments available are mentioned below:
The two most common and effective treatments are:
Topical silicone gel or creams or sheets are useful to some extent.
Intralesional steroid or 5FU or verapamil injections are often used to stop the growth of keloids. Injecting long-acting cortisone (steroid) into the keloid once a month is the most effective first-hand treatment.
Retinoic acid, Interferon (IFN) therapy, doxorubicin, bleomycin, imiquimod 5% cream, tamoxifen, and tacrolimus
Antiangiogenic factors, including vascular endothelial growth factor (VEGF) inhibitors (eg, bevacizumab),
Photodynamic therapy, UVA-1 therapy, transforming growth factor (TGF)–beta inhibitors, tumor necrosis factor (TNF)-etanercept, which are all directed at decreasing collagen synthesis.
Compression therapy or Pressure garments it suppresses collagen production. Occlusive scar dressings should be worn for at least two to three months and can be extended as per requirement.
Treat secondary infection in time, drain the abscess and sinus, and remove coiled hair inside the keloid.
Cryotherapy refers to a treatment in which surface skin lesions are frozen. Liquid nitrogen is the most common cryogen used by dermatologist (–196°C) most commonly used for small or limited keloids, most suitable and is often used parallel to steroid injections.
Laser therapy: very good at improving skin texture and color, and in combination with other treatments flatten out the keloid.
Pulsed Dye Laser: PDL is most effective if used early and in combination with other techniques. The principal effect of a pulsed dye laser is on scar microvasculature, reducing erythema and pruritus, and improving skin texture and significant improvement in the scar.
Long Pulsed 1064 Nd:YAG: This laser was developed for the treatment of vascular diseases, including inflammatory scars that works by suppressing neovascularization in hypertrophic or keliod scars, which are characterized by vessel overgrowth that results in nerve fibers and collagen in the reticular layer of the dermis.
Fractional Co2 creates deep channels into thick scar tissue with debulking mode; and if used in combination with collagen remodelling agents can almost flatten the hypertrophic scar and keloids. The procedure is required for few consecutive months.
Fractional MNRF and individual radiofrequency devices in combination with cryo and intralesional steroids give excellent results.
Enerjet: Hyaluronic acid (HA) is a glycosaminoglycan that plays an important role in the reorganization of the extracellular matrix (ECM) during the skin wound healing process. Decreased presence of HA is a major characteristic of keloid and hypertrophic scarring
Enerjet uses Jet Volumetric Remodelling (JVR) technology a high-pressure jet technology to laterally introduce healing agents deep into the dermal layer of the skin for the reduction of keloid.
Surgical excision: Surgical Removal is can be done for larger, more extensive, and especially over the ears. The technique involved may employ a scalpel, radiofrequency device, or CO2 laser removal. It’s better to avoid surgical excision as it may result in a new keloid, and even larger than the original one.
Radiation therapy: carried out soon after surgery
We at Clear Skin laser centre provide all the above mentioned, advance, and evidence-based laser keloid treatment. Treatment protocol for the management of these scars will extend from 6 months to 2 years; once in a month as out-patient based sessions.
We at Clear Skin Centre treat keloid and hypertrophic scars with: