5 weeks post impact injury, and a hypertrophic or keloid is starting to form on good skin, what do I do? (Photos)

Question

Had an impact injury from a cricket ball. Top part of the scar is healing okay. I think laser + surface treatments will suffice there in due course. I'm worried about the bottom part as there is a growing thickness hypertrophic or keloid part growing into good skin away from the wound line. The red line I've drawn is where the closure line was and the thick, hard raised lump is getting thicker. Do I get steroid injections now to stop this? I worry about a wider scar removal later

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Based on your concerns, I recommend treatments with a PICO laser and/or CO2 resurfacing lasers in area of concern to help break down the pigmentation and even out the skin tone/texture. I hope this helps and best of luck!

Anna Chacon, MD, FAAD · Answer

It sounds like you're dealing with a hypertrophic scar or possibly a keloid, which can indeed be distressing and challenging to manage. Since you're five weeks post-injury and noticing significant changes, it's important to take timely action. Here are some steps and considerations for managing the hypertrophic or keloid scar:

1. **Consult a Dermatologist or Plastic Surgeon**: This is the most crucial step. A specialist can provide an accurate diagnosis and tailor a treatment plan specific to your condition. They can distinguish between hypertrophic scars and keloids and recommend appropriate interventions.

2. **Steroid Injections**: Intralesional corticosteroid injections, such as triamcinolone acetonide, are commonly used to reduce the size and thickness of hypertrophic scars and keloids. These injections can help flatten the scar and reduce redness and itching. Early intervention can be beneficial, so discussing this option with your doctor promptly is advisable.

3. **Silicone Gel Sheets or Scar Creams**: These are often recommended as first-line treatments for managing scars. Silicone gel sheets or topical silicone gels can help flatten and soften scars over time. They work by hydrating the scar tissue and regulating fibroblast production, which can reduce scar formation.

4. **Pressure Therapy**: Applying pressure garments or silicone sheets can help in reducing hypertrophic scars. This method is more effective for scars in areas where pressure can be maintained consistently.

5. **Laser Therapy**: While you mentioned considering laser treatments for the top part of the scar, it might also be beneficial for the lower part. Laser therapy can help reduce redness, improve texture, and flatten the scar. However, it's typically used as part of a comprehensive treatment plan and may be more effective after initial scar maturation or in conjunction with other treatments.

6. **Avoid Trauma to the Area**: Protect the scar from additional trauma, irritation, or friction, as these can exacerbate hypertrophic or keloid formation.

7. **Consider Cryotherapy**: For keloids, cryotherapy (freezing the scar tissue) can sometimes be used in combination with steroid injections to enhance results.

8. **Follow-Up and Monitoring**: Regular follow-up with your healthcare provider is essential to monitor the scar's progress and adjust treatment as necessary.

Early and appropriate intervention is key to managing hypertrophic scars and keloids effectively. Steroid injections are a common and effective treatment, but they should be administered by a healthcare professional. Combining treatments like silicone gel sheets, pressure therapy, and possibly laser therapy under the guidance of your dermatologist or plastic surgeon can optimize outcomes and minimize the risk of a wider scar developing.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

5 weeks post impact injury, and a hypertrophic or keloid is starting to form on good skin, what do I do? (Photos)

Answers (3)

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Everything you need to know about Scar Removal

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5 weeks post impact injury, and a hypertrophic or keloid is starting to form on good skin, what do I do? (Photos)

Answers (3)

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Everything you need to know about Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.