i am an african american, male, 39 yrs old that wants to get rid of a keloid that appears on my ear lobe. my family dr said i need steroid injections. but is that the safest keloid treatment? what other options are there?
What is the Best Keloid Treatment?
Doctor Answers 24
Treatment for Keloids is Difficult
As others have noted, effective treatment of keloids can be very difficult. The reason for this is that keloids are an abnormal response to injury, and area of scar tissue that grows beyond its natural boundaries. On examination of a piece of Keloid tissue under a microscope, it looks substantially different than the average scar. The initial phase of treatment is to slow the inflammation, ergo the use of several spaced injections. The next option is to excise the scar surgically (50% recurrence rate) or to treat with radiation. After excision, the area can be radiated and/or re-injected with steroid. Some Surgeons advocate placement of topical mitomycin and/or topical 5 flurouracil at the time of excision. Despite all of these options, keloids can and do recur.
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.
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.
Keloids Are Difficult
Keloids are unfortunately one of the most difficult conditions to treat successfully. There has been no treatment shown to be 100% effective at treating keloids. There are many options though. Be ware that even with optimal treatment, recurrence occurs and can occur even several years after treatment.
1) Steroid injections: With smaller keloids, this can completely resolve the keloid. With larger keloids, steroids are used to soften the keloid, decrease the amount to be removed, prepare the area for excision, and hopefully prevent recurrence after excision.
2) Excision: For larger keloids, excision must be undertaken. In addition to excision, another treatment must be performed to decrease the chance for recurrence. Without another treatment, there is almost a 100% recurrence rate for keloids after surgical excision.
3) Radiation treatment: The most aggressive treatment for keloids involves excision followed by a short radiation treatment. This should be reserved for severe or recurrent cases not amenable to other treatments. Radiation therapy does have long term risk of cancer.
4) Silicone sheeting & Pressure: After excision, application of silicone sheeting and pressure earrings has been shown to be superior to excision alone at decreasing recurrence.
5) Topical or Injectable medications: There are several medications which have been tried to decrease recurrence. These include the steroids, mentioned above, several chemotherapy agents, and a topical medicine called Imiquimod. Imiquimod has shown great promise for treatment of keloids after excision. In some studies there is almost a zero percent one year recurrence rate. Of note, all of these uses of the medication are off label.
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Keloids need expert care
It is important to work with a physician who has significant experience with Keloids - as in this case experience matters greatly. There are many options for treating keloids including pressure, injections of cortisone, and surgery. When considering surgery, we have found the use of Radio-frequency surgery to be far superior than the conventional scalpel. This allows meticulous dissection of the scar tissue without any crush (from a blade) or thermal damage.
There are several treatments for keloids
Keloids are thick scars that form after injury or trauma, but can also occur on their own. They can happen anywhere on the body but are common on the earlobes and trunk (especially the chest and upper back). Any form of injury to the skin, including surgery, ear/body piercing, accidental injury, or a tattoo can cause a keloid.
You should consult a board-certified dermatologist to discuss the treatment options. Steroid injections are often helpful for small keloids or to prevent keloids after surgery. These usually need to be repeated monthly for 3-4 months.
Surgery is also often used on the earlobe to debulk or remove the keloid. The recurrence rate can be high, so it is important to inject the keloid monthly after surgery.
There are other rarer or more experimental treatments like radiation therapy or imiquimod cream that are sometimes used for severe or difficult to treat keloids. These should only be considered in consultation with a dermatologist or plastic surgeon who is familiar with keloid treatment.
Keloids respond to steroids and radiotherapy
For indiviuals like yourself prone to keloid formation, having the keloid excised and injected postoperatively may prevent recurrence of the keloid. If the keloid does recurr, conmsult a radiotherapist in your are that does this superficial radiotherapy- it can reduce recurrence by more than 80%.
Often keloid treatments of the ears require a multi modality approach with the following therapies:
- Surgical excision- In some cases the keloid must be excised because other therapies are not effective. Surgery alone is rarely effective in managing keloids
- Kenalog injections- Kenalog injections decrease the collagen response and help improve the chances of keloids from returning.
- Pressure clip earrings- Pressure on the ears is thought to decrease the collagen injections
- Silicone sheeting- Unknown mechanism of action but thought to place a negative charge on the scar to improve keloid response
- 5 FU injection- Can be used if above is not effective.
True keloids are hard to improve
Hopefully you do not have a "true Keloid," but rather a hypertrophic scar. You need to be evaluated to discern the difference. Keloids tend to recur and spread widely out of the wound from which they were formed. Radiation therapy is a seemingly drastic option after surgery for Keloid scars that seems to work.
Keloids are actual tumors of scar tissue. They are an abnormal response to injury and occur often after minor trauma (earlobe piercing, shaving of the beard). The defining characteristics are the growth of the scar outside of the area of injury. The scar is composed of massive amount of collagen when looked at under the slide. In theory, it is an abnormal inflammatory response which may be the underlying cause. No singular treatment works best and often a combined approach is necessary. Here are the most common types of treatment:
- Removal of the scar surgically (>50% recurrence rate)
- Steroid injections (typically multiple injections over time)
- Pressure devices
- Radiation therapy
- Interferon alpha injections
Keloids will often grow to a certain size then stop. Steroid injections after the keloid has plateaued in growth may soften a keloid, but rarely decrease the size. For the earlobes, I recommend a combination of surgical excision with immediate steroid injection. The steroids are repeated every 6-10 weeks for 3 more injections. Soon after excision, pressure earrings (sold at most department stores) are placed to apply a constant pressure to the healing site. Even with all of these treatments performed in continuity with each other, the recurrence rate can approach 30-35%.
Keloid treatment requires a frank discussion with your plastic surgeon prior to any treatment. Compliance with therapy is essential and even in the best of cases, the keloids may return, or even worsen.