Itching and Painful Keloids - Treatment?

I have treated thousands of keloids and have found that my protocol, which incorporates multi modality treatment, works best. Raffy Karamanoukian Los Angeles

Symptomatic keloids that are refractory to treatment are a very difficult problem. Frequently, multi-modality treatments are required. This usually includes surgical excision, intra-operative steroid injection, immediate post-operative low dose radiation therapy and possible even follow-up steroid injections. Particularly if you have failed therapy in the past, aggressive re-treatment is usually required.

Typically, following removal of a keloid, effectiveness of treatment may be increased with immediate injection of kenalog followed by potential monthly injections as indicated. These need to be followed very closely due to their moderately high risk of recurrence which may be for at least 18 months.

If radiation treatments are elected, they should start within 24 hrs of the surgical removal.

Many times when radiation is applied, it is not done with the right interval leading to a high chance of failure.  The radiation must be started within 24 hours after complete surgical excision.  Although the success rate is not 100%, it greatly limits the chance of success if you do not time it right.  Again, it must be right after surgical removal.  That is the first thing.  As far as things you can, silicone gel over it can help but not too much.  But I would try it too.  I have found that injections with steroids and without timed surgery and radiation leads to too high a failure risk.

As far as prevention, barring an abnormal skin condition, you have to evaluate what may be causing it.  Are you picking at your skin leading to the problem?  Are you having ongoing cystic acne that could be controlled?  If not, you really need to see a dermatologist to make sure that the right diagnosis is in fact a keloid.

best,

Dr. Sam Lam

Dallas, Texas