Keloid scars, which represent an exuberant proliferation and ove abundance of abnormal fibrous collagen, unlike other kinds of scars, typically project upwards and spread out beyond the confines of the original wound (whether traumatic, surgical, or inflammatory) sites. Because these kinds of scars form in people with an inherited tendency, they tend to recur at the same site or even come back larger after attempted surgical or destructive removal.
A good first line treatment is to inject keloids with intralesional corticosteroids, in an attempt to shrink them. Keloids treated successfully in the is fashion become flat, atlhough an ivory colored scar flush with the skin surface typically results. Most people, especially those suffering not only from the unsightly nature of the scar, but from other symptoms, such as redness, itching, tenderness or pain, will often find relief from this approach.
When lower doses are not successful, higher concentrations may be tried and other agents, such as 5-fluorouracil added to the injection mixture in an attempt to shrink the keloid. Sometimes, the keloid may need to be frozen with liquid nitrogen prior to injection therapy in order to soften it enough to permit thorough permeation of the injected materials.
Other times, the upwardly projecting portion of the keloid may be sculpted off the site to debulk the area and then the site may be subsequently injected. Still other times, a prescription medication, imiquimod, may be recommended for home use to suppress keloid reformation between in-office treatments.