Keloid treatments other than steroids
As Dr. Trimas has pointed out, pulsed dye laser treatments are an option to change the healing response in keloid scars.
When the scars are fresh, there is a very high vascular (blood flow) component. Using pulsed dye lasers when keloids are relatively new can help to diminish the blood flow to the scar, which can stop or even reverse it's growth. While it is not one of the most common treatments, it is a good option to consider.
Keloids that do not respond to corticosteroids
Perhaps you did not have a sufficiently high concentration of corticosteroids to achieve the desired effect. If Kenalog (cortisone) injections really are not working for you, other options include 5-fluorouracil injections and cryotherapy (risky though if you have darker skin). I would suggest in the interest of safety, if your practitioner decides to try a treatment other than corticosteroid injections, a test spot be performed in a small area of scar before the treatment is more widely administered.
The mainstays of treatment are:
- occlusive dressings and
- kenalog injections
other than that a variety of other interventions include:
- interferon (IFN): alpha, betal gamma
- chemotherapy (cytotoxic agents): 5-fluorouracil (5-FU), doxorubicin, bleomycin, verapamil,
- imiquimod 5% cream
- botulinum toxin,
- allium cepa
- antiangiogenic factors, such as vascular endothelial growth factor (VEGF) inhibitors (eg, bevacizumab)
- phototherapy (photodynamic therapy [PDT], UVA-1 therapy, narrowband UVB therapy)
- transforming growth factor (TGF)–beta3,
- tumor necrosis factor (TNF)-alpha inhibitors (etanercept)
- recombinant human interleukin (rhIL-10)
Best treatment for keloids that don't respond to steroids
I agree with very low dose radiation provided by your local hospital's radiation therapy department. Make an appointment to discuss with the Radiation doctor and understand the risk/benefit ratio.
Keloid treatment on the neck
If you are not responding very well to kenalog injections, you might request that the physician increase the strength. I would also add vascular laser treatments to the mix as I have found it to be very effective in treating fresh keloids especially ones with red color in them.
Other conservative treatments include use of silicone gel sheeting that you can buy over the counter. I hope this information helps.
Keloid scar treatment with excision and radiation
The best modality in your case may be low dose radiation. This is best combined with excision of the keloid scar via surgery. Generally, the first radiation is performed on the day of scar excision and everyday for about 5 days. This is sometimes combined with steroid injections at a later stage. I have had fair results with this approach on my patients.
Keloid VS Scar Hypertrophy
The way wounds heal depend on many factors, including
- mechanism of injury (knife, scalpel, burn, caustic fluid, blunt trauma etc)
- location on the body (the extent of skin movement and tension will determine how things heal)
- how was the injury treated (you say your wounds were not stitched...)
- your ethnic background (the darker the skin, the more vigorous the healing response)
- genetics (if your parents have a history of REAL keloids the odds are you will as well)
Most people refer to ALL raised scars as "Keloids". That is NOT the case. A scar that is raised from the plane of the skin, resembling a speed bump - that is it does not exceed the limits of the original injury is SCAR HYPERTROPHY. On the other hand, when a scar exceeds the original injury, such as ear punctures that result is cherry-like scars - those ARE real KELOIDS.
If your neck skin is soft and supple, you may want to see a plastic surgeon (www.PlasticSurgery.org) and have him try a SCAR REVISION on you. It MAY correct these scars nicely. I would NOT do it if you have true keloids or the wounds have not yet totally matured.
Neck keloids and treatment
Neck keloids can respond to a combination of pulsed dye scar laser, IIT, surgery, and pressure. I would begin therapy soon to prevent progression of the problem.