I have had 3 different procedures done to stop the keloids from coming back. For the first two surgeries I had steroid injections and the third surgeon decided to try radiation treatment,my keloids returned after a year or so. What should I do?
Reoccurring Keloids - How Can I Get Rid of Them?
Doctor Answers (7)
Recurrent keloids - treatment options
Keloids can be difficult to eradicate without recurrence and usually you will require more than 1 modality. You have failed 3 previous treatments though it is unclear what the regimen was for steroid injection after your surgical procedure. Furthermore, it is unclear how long you were followed for.
My recommendation would be for surgical removal with intraoperative injection of steroids and then monthly rechecks and possible reinjections. You may need to be seen in this fashion for up to 1.5 to 2 years. You have previously had radiation and I would be hesistant to recommend that it be repeated. Adding 5 FU could be a consideration as well
Treatment for resistant keloid scars
I have found low dose radiation to be very effective. It is essential that a protocol be followed that involves the first dose as close to immediately after the procedure as possible. The next dose should be 48 hours later and the last dose 72 hours after the procedure. I would suggest that you try radiation again, particularly if this dosage regimen was not followed.
Excision and serial steroid injections every 4-8 weeks is the treatment of choice for keloids
Excision and serial steroid injections every 4-8 weeks is the treatment of choice for keloids. Based on a literature review, this is the treatment of choice. Radiation therapy is very outdated in my opinion and I would not resort to that even as a last choice. That is my opinion based on scientific evidence. I have spent a lot of time in a keloid rich region at Louisiana State University in Shreveport Louisiana. One approach they do is to allow the excision to heal with secondary intention. That is cutting out the keloid and then letting them heal on their own. Rather barbaric to some, but there is scientific evidence to suggest that this could be a good alternative. I have done this for someone withe keloids in the beard pattern from ear to ear (ie very large). I've treated the worse cases though.
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Keloid Removal: Timed with Radiation
May I ask a simple question: was your radiation timed to start exactly less than 24 hours after the keloid was removed? If not, the odds of success diminishes within one to 2 days from 95% to 30%. You must remove the keloid and have planned radiation to follow immediately following otherwise it will fail almost definitely. If you failed radiation, good news because it is low dose you can have it again. That is the still to me the gold standard: good surgery with timed radiation. Almost everything else has a high failure rate.
dr. sam lam
p.s.: watched the attached video
Another possibility for recurring keloids
Keloids are notoriously difficult to get rid of. Another option that you may not have tried involves using imiquimod cream (Aldara). There have been a few studies that suggest it helps when used after keloid surgery. Otherwise there are a lot of trials going on now with new mediciations for keloids and hypertrophic scars. With luck, we may have some of these new meds in the US in several years.
Keloids are very difficult to get rid of, especially if your body is "programmed" to form these thick, raised, and often painful scars. Excision and immmediate radiation works for most people. Another more new technology involves excising the scar and placing a regenerative matirx called ACell Matristem on the wound. This material allows for regeneration of normal tissue and early results seem to be positive in situations like recurrent keloids. Very few doctors are familiar with this product. I have been using it in complex reconstructions since its approval in this country.
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