I am African American and have a very thick, very raised, approx. 10 inch keloid scar on my neck, and a trachea scar that turned keloid as well. They are about 2 years old. I am at the point where I am trying to get these removed. Where do I start?
Best Keloid Removal Advice for African American Skin?
Doctor Answers (6)
Keloid Treatment in African Americans
Currently there is no cure for keloid scars. The only known treatment that has been shown to decrease the recurrence of keloids after treatment is surgical excision followed by 3 consequetive days of low dose radiation therapy. It doesnt matter what method is used for excision; scalpel, laser etc. The objective is to remove the keloid and then treat the skin edges with radiation. The recurrence rate for keloids is between 50 and 60% regardless of the method used.
Keloids on the neck can be challenging
A combination of excision (preferably with radio-frequency surgery), and steroid injection is a good start. Postoperative and routine steroid injections can be beneficial as well. You may want to discuss with your surgeon the risks and benefits of healing by second intent (ie: without stitches)
Keloid Treatment for African American Skin
Keloids can be very resistant to treatment.
Treatment options can involve any of the following (and also involve combinations of the therapies listed below).
1. Steroid treatment - this usually requires multiple treatments. If the keloid is large enough this can leave excess skin after successful treatment. Steroid treatment can cause tissue atrophy and for african american skin or other darker skin types can also cause hypopigmentation - meaning the skin may be lighter in the treated area.
2. Excision - While the mechanism for steroid formation is not fully understood wounds that have issues with contamination or infection may be at higher risk for keloid formation. Excising the keloid with a meticulous closure can effectively treat even keloids that have recurred.
3. Radiation - For extremely resistant or disfiguring keloids radiation therapy can be an effective mechanism to reduce recurrency rates in combination with surgical excision.
I hope this helps.
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Managing keloid scars on the neck
Keloid scars on the neck are difficult to manage as recurrence rates are very high. Nonetheless, successful treatment is well worth it and patients are elated with the results. Surgery or excision should not be the mainstay of treatment unless all conservative measures, including silicone application, pressure dressings, TAC injection, and 5FU treatment is exhausted. I routinely administer aggressive non-invasive modalities in the initial period with great success.
Steps in Management:
- Begin with kenalog injections to see if it is responsive. This also tends to make the keloids less symptomatic within a matter of days (less burning/itching).
- Consider use 5-FU injections which has recently been shown to be of some benefit.
- Surgical excision with/without steroid injections and postoperative pressure and silastic sheeting.
- Surgical excision, steroid injections, and radiation therapy as a last resort.
Seek treatment from a physician with experience in the management of keloids. They can be very difficult to manage.
Excision, kenolog injection for keloid removal
A combination of excision,kenolog injection is a good start. Consultation with a board certified plastic surgeon is a good start. Resistant cases might require radiation but i would not use this modality except in severe cases.