Keloids, by contrast, may start sometime after a cutaneous injury of any type including normal acne, minor burns, chickenpox, ear piercing and piercings in general, minor scratches, surgical incision, injections, tattooing, laser aesthetic treatments including skin tightening, more in general any event which will trigger the skin regeneration process. They can also develop after some minor inflammation. Often Keloids can be mistaken for hypertrophic scars and vice versa. Keloids tend to extend beyond the wound site. This tendency to migrate into surrounding areas that weren't injured originally distinguishes Keloids from hypertrophic scars. Also, another difference between Keloids and hypertrophic scars is that Hypertrophic scars are formed during the healing process and stop developing as soon as the area has healed, on the other hand, Keloids do not stop growing when the healing process is over. Sometimes Keloids keep growing weeks after the original injury has healed.
Keloids "per se" are benign and non-dangerous growths, however, they can be compared to benign tumours due to their tendency to sustain growth after their initial formation. In case the growth seems disproportionate and persists over the period of several weeks leading to abnormal (irregular) shapes and disproportionate dimensions, like in case of formations displayed in Figure 4 for example, then excision for a histological examination is recommended. This is to make sure the growth although abnormal is benign. Please bear in mind that there is no scientifically proven connection between Keloidal formations and dangerous growths.
The difference between a classic Keloidal formation and a Hypertrophic scar is noted by comparing Figure 5 with Figure 2 and 3. The Keloidal formation in Figure 5 is clearly protruding and it does not present the normal pinkish colour of a normal Hypertrophic scar which is clearly confined within the borders of the original injury. Also in figure 5, it is possible to notice how the Keloidal formation is overgrowing in a similar fashion to the ones in Figure 4. In Figure 6 on the left, we can appreciate the clear Keloidal formation after heart surgery. The Keloids also formed on the suture points.
The Hypertrophic scars, in contrast, are very well confined within the original boundaries of the wound that initially formed it (See Figure 2 and 3). Keloids affect both sexes equally, although the incidence in the young female population has been reported to be higher than in young males, probably reflecting the greater frequency of earlobe piercing among women. The frequency of Keloidal occurrence is 15 times higher in highly pigmented people (skin types 4, 5 and 6), therefore African, Asian and Indian descendant people have increased likelihood of Keloid occurrences. It is also shown that the tendency to form Keloids is familial, therefore if one of your ancestors had this tendency then you will be more likely to form Keloids.
- Triamcinolone acetonide
- Lasers (by vaporising the Keloid) coupled with preventative measures to minimise recurrence.
- Voltaic Arcing (vaporisation) coupled with preventative measures to minimise recurrence.
- Surgical Excision coupled with preventative measures to minimise recurrence.
- Cryotherapy combined with preventative measures to minimise recurrence.
- Micro dermal abrasion combined with preventative measures to minimise recurrence.
- The most common Keloid recurrence minimisation method is the use of corticosteroid injections after any of these types of ablative treatments. This is due to the availability, efficacy and relatively low side effects of these drugs. In most cases, the injections are administered both before the ablation treatment directly into the Keloid and after the removal treatment into the surrounding area using superficial infiltrations.
- The use of Radiotherapy and other methods have been proved to be also effective.
- A particular study also suggests the use of Silicon Gel Sheeting up to 48 hours after an ablative treatment as a means of reducing the likelihood of recurrence. As the results are not always satisfactory this is not a first line preventative therapeutic treatment recommendable after Keloid ablative treatments. Click Here to learn more.
- Other promising Keloid recurrence preventative therapies after removal using ablative treatments include antiangiogenic factors, including vascular endothelial growth factor (VEGF) inhibitors (eg, bevacizumab), phototherapy (photodynamic therapy, UVA-1 therapy, narrowband UVB therapy), transforming growth factor (TGF)–beta3, tumor necrosis factor (TNF)-alpha inhibitors (etanercept), and recombinant human interleukin (rhIL-10), which are directed at decreasing collagen synthesis.
Home treatments should not involve cutting, sanding, constricting the keloids with strings or rubber bands, or using any other method that traumatizes the skin. Doing so can increase the likelihood of recurrence, infections or keloid enlargement.
Use care when attempting home remedies for Keloid removal. Safe and effective remedies to shrink Keloids include occlusion (silicone pads or gel) and/or the application of certain substances. Please note that despite the fact that the proposed treatments are scientifically proven to improve the appearance of Keloids over time, several treatments, over a long time period are usually required in order to achieve the desired results. The duration of the treatment depends on the method used. The following home treatments are also effective in the treatment of normal Hypertrophic scars. Dramatic results are only currently achievable using intra-lesional corticosteroid injections or ablative methods combined with recurrence preventative treatments.
Silicone sheeting (Simple occlusion).
Occlusion in the treatment of scarring of any type has been used for several years. Occlusion can be performed in several ways, one of the ways which have been widely used is the application of Silicone adhesive sheets or appropriate silicon gel. Also, silicon gel sheets have been used to prevent new Keloids from forming following an injury or surgical operations. This is a treatment that can lead to eventual improvement in the appearance of both Hypertrophic scars and Keloids.
However, the use of sheeting has to be endured over several months (usually over six) in order for the results to become apparent. Therefore this type of treatment although ultimately effective is unsustainable for most people as this requires forming a new daily habit which needs to be sustained over months and this is rarely accomplished. Most "ad hoc" products are silicon gel sheets, or "scar sheets" which are self-adhesive, and reusable. They are applied to existing scars and Keloids to reduce their size and appearance over time. Silicon sheets should be worn over them for at least 10 hours per day for several months in order to achieve the desired results.
Silicon gel sheets are widely available on the market and can be bought at most pharmacies and many online retailers.
Vitamin E Coupled with Occlusion.
The use of topical Vitamin E based products (gel, oil, and ointments) have been shown a real efficacy in the eventual reduction in the size of the Keloid over a long period of time (several months). Therefore this solution on its own is not suitable for most people, because the use of this type of products can hardly be sustained over long periods. Likewise, as we know, the main problem with occlusion, used on its own, is the impracticality of wearing silicon sheets or gel products over long periods during the day (over 10 hours per day) and over sustained long periods of time (over 6 months). However, the combination of occlusion and the use of Vitamin E based products appears to be far more practical as the results are achieved much faster, usually within 2 months with an appropriate everyday use.
The reason for silicon occlusion to be effective in the treatment of Keloids is the "direct action on the fibroblasts and a hyperhydration of Subcutaneous tissue". Because generally the use of occlusion in aesthetic is successfully used for amplifying the subcutaneous delivery of active substances. Therefore applying Vitamin E on to the Keloid coupled with the occlusion effect of silicone sheets speeds up the Keloidal shrinkage process which would otherwise be possible. To view the related scientific study showing the efficacy of Vitamin E coupled with occlusion in Hypertrophic scar and Keloid treatment please Click Here. Please note that results vary according to the type of topical Vitamin E based product, time of occlusion carried out during the day.
Keloids are fundamentally different from Hypertrophic scars. Keloid removal treatment is not always simple as it is in the case of hypertrophic scars.This is because, unlike Hypertrophic scars, Keloids tend to "grow back" after any ablative treatment.
There are two main types of possible effective treatments:
- Professional. The first line of treatment is the use of Intralesional corticosteroid injections. Failing that the preferred option is the use of ablative treatments (Physical removal of the Keloids) combined with some other recurrence inhibition treatment. There are also several other options, however, they are not frequently used yet.
- Home treatments. The most successful type of home treatment is the use of suitable Vitamin E topical products, combined with occlusion. If carried out appropriately, this type of treatment has been shown to reduce the size of most Keloids within 2 months.
Both professional and home treatments are effective.
Professional treatments bear the advantage of allowing the Keloid removal with high success rate within one (or multiple) sitting(s) without the client needing to wear patches on his own. The main disadvantage is the higher costs and the potential side effects.
Home treatments are effective however, this does require the sustained daily use of Vitamin E based product coupled with occlusion over an extended period of time during the day and over several weeks. The main advantage is the lower costs and the very low likelihood of side effects.