Keloid scars are very common in plastic and cosmetic surgery clinical treatments and outpatient consultations. Every day, we receive a large number of patients suffering from keloid scars, and the prevention and treatment has been a challenge for modern medicine. Keloid scars not only affect the aesthetics, but even lead to dysfunction, which seriously affects the physical and mental health of patients.
1. What is a keloid?
Keloid is a necessary process for trauma repair, but excessive proliferation of keloid is not good and is a pathological process. Keloid is the pathological process, often as a raised plaque or papule, the size of which exceeds the border of the primary wound, cannot spontaneously fade, and often recurs after excision. The etiology and pathogenesis are still unclear, and treatment is difficult. Some have achieved better results, but none can completely cure and prevent recurrence.
2. Why does it occur?
Keloid scars are almost always secondary to local injury. Surgery, ear piercing, burns, lacerations, abrasions, tattoos, seed pox, insect bites, etc. can cause keloid scars. Long-term failure to heal the injury is a contributing factor, and keloid scars are likely to occur if the epithelium does not grow back in more than 10-14 days. Tension of the wound is another cause of morbidity. Local inflammation is also a cause of keloid scarring. Therefore, acne, chicken pox, and folliculitis are prone to keloid scarring, and acne keloid is the most common.
3. What are the treatment options?
Keloid scars are difficult to treat and the treatment is now more or less controversial. However, the following are the main treatments: (1) Local injections: corticosteroids, 5-fluorouracil (5-FU), bleomycin, interferon, etc. Some local injections have been used to treat keloids, and some have been used clinically with good results. Combining multiple drugs for topical treatment is more effective than using one drug alone for topical treatment.
(2) Silicone film: Closure after encapsulation leads to hydration of the stratum corneum, while increasing the oxygen pressure within the scar, resulting in thinning and flattening of the scar. There are a variety of finished silicone products available, commercially available as creams, gels, silicone films, silicone bands, sprays, foams, etc. There are even clothes made of silicone on sale.
(3) Compression therapy: Wearing an elastic bandage can treat keloids with the recommended pressure of 20-40 mmHg for 24 hours a day for 6-12 months. However, due to the long treatment time it is difficult for most patients to accept. Postoperative compression therapy is an important method to prevent recurrence.
(4) Surgical excision: If silicone and local hormone injections do not work after 12 months of application, surgical treatment can be considered. However, except for keloids in the earlobe where recurrence is rare, surgical excision of keloids alone has a high recurrence rate in all other areas. The growth of scar tissue is more severe after recurrence. Adjunctive application of other treatments after surgery is recommended.
(5) Cryotherapy: Liquid nitrogen freezing has an efficiency of 66-75%. It is best used for smaller rashes, such as keloids caused by acne. Cryotherapy combined with hormone injections in the lesion may have a synergistic effect and is better than cryotherapy alone.
(6) Laser: 585 nm dye pulsed laser is more effective in treating keloids, it has higher vascular specificity than CO2 laser, and studies have shown that laser treatment of chest keloids can significantly improve erythema, pruritus, and scar height, and the improvement in symptoms can last up to 6 months.
(7) Radiation therapy: Radiation therapy can be used alone or in combination with surgery, usually 24h postoperative radiation therapy, which is most effective for severe keloids.
(8) Local topical medication: including: Imiquimod, vitamin E, onion extract, etc.
4.How to prevent in life?
Try to avoid trauma. If you are injured, strictly follow the basic principles of trauma treatment, and treat small wounds as soon as possible to make the epithelium grow and heal as soon as possible. Any method that promotes skin healing as well as reduces skin tension can reduce the incidence of keloids. If the ears are pierced, wearing some compression earrings can reduce the incidence of keloids. Patients should be asked if they have a previous history of keloid scarring before any procedure. Be aware of potential predisposing factors for keloids, such as prolonged wound non-healing and excessive tension on incision sutures. If surgery is necessary in keloid patients, silicone products or topical hormone injections should be given immediately after surgery.
Keloid is an overproliferative reaction. Patients prone to keloid are often younger than 30 years old, have a genetic predisposition, and are prone to keloid in dark-skinned people, and Chinese are more prone to keloid than other Asians. The chest, shoulders and upper arms, earlobes, and cheeks are the preferred sites. Once formed, keloid scars are difficult to treat and have a high recurrence rate regardless of treatment. The final choice of treatment depends on the size and location of the lesion, the age of the patient, the recurrence rate, cosmetic requirements, the experience of the physician, and the patient’s self-requirement.