Keloid and Hypertrophic Scars

What are keloids and hypertrophic scars?

Some individuals have a tendency to heal excessively and this can present as a raised hypertrophic or a keloid scar. Keloids tend to extend outside the edges of the surgical wound. They may be itchy in the initial stages and redness can develop due to the presence of blood vessels in the healing tissue.  Raised keloid scars are more commonly seen in Afro-Caribbean and Indian races. Common sites include the trunk and at sites of body-piercing including the external ear. They are also known to develop if the surgical wound has been stitched under tension. In surgery for malignant melanoma, adverse scars are more commonly experienced because the wounds have skin removed and are stitched under tension. 

Pictures

Keloid chest Keloid scar ear-piercing Atrophic stretched scar

Is treatment necessary?

Hypertrophic or keloid scars generally do not require any specific treatment. Any itch or discomfort will generally improve within four months of diagnosis and symptoms may be helped by the application of a topical steroid for several months. Application of a simple moisturiser may be sufficient to help relieve any minor discomfort in the wound. 

Treatment Options

Occlusion of the wound with silicone gel or occlusive sheets may help to flatten raised scars and improve the symptoms experienced by many patients. They need to be applied daily and are available over-the-counter from pharmacists (typically costing 25-30 for 4-6 weeks). They should be used for a minimum of 4-6 months to achieve optimum results. A new gel formulation is beneficial for treating difficult areas.

Potent steroids shut down the blood supply and can help flatten and reduce the itch of keloid and hypertrophic scars. Dermovate ointment can be applied once daily on a trial basis for 8 weeks. Other alternatives include Haelan tape, which is an impregnated tape with a topical corticosteroid. More persistent raised lesions may benefit from a steroid injection directly into the scar. These treatments will not remove the scar but may help to flatten the appearance and reduce the symptoms of itch. Local injections may be painful and occasionally produce a depressed scar.

Keloid injected triamcinolone Keloid distended by triamcinolone

Vascular lasers may be used to reduce the redness of raised hypertrophic or keloid scars by closing down the blood vessels in early scars. This treatment is generally more effective in the first few weeks following development of the scar and will not normally benefit the scar unless some redness is present. IPL lasers will also stimulate new collagen formation.

Skin surgery is rarely used to remove keloids or hypertrophic scars because the over-healing process may recur. The resulting scar can sometimes be larger than the original scar. The outcome is more favourable in surgical wounds that develop abnormal scars due to complications. In these wounds scar revision by surgery may be more successful. Keloid scars following ear-piercing may need to be removed because of there large size. Surgical excision may be combined with radiotherapy. This is available locally in Brighton.

Keloid following ear-piercing Removal of keloid and stitches Keloid over-growth of cartilage Final result at 12-months